Blog Archives

BREAKING: House and Senate appear close to a Medicaid deal!!

In our last post on Medicaid reform, we updated you on the recent bill passed by the North Carolina Senate relating to the long-standing thorn in the side of the General Assembly, especially regarding the states’ budget – the Medicaid program. The Senate’s version of Medicaid reform is quite different from what we have previously seen and is a hodge-podge of managed care and a new idea: “provider-led entities.”

In a strong sign that this proposal is a compromise between competing sides that could end up getting passed, both House and Senate leaders are speaking positively on the record to news media about the prospects for a deal. Given how public the issue is and how big it is (an expected $14.2 billion in North Carolina in the coming year), that means they expect to get a deal done soon. The fact that the issue is so tied up with the budget that is overdue to be passed is a further headwind to passing a bill.

Right now, the bill is in a conference committee of negotiators from the House and Senate to work out an agreement, given the differences between the two chambers.

One major issue that the committee needs to look at is whether there will be a whole new state agency: the “Department of Medicaid.” The Senate endorsed that idea last week.

Our prediction: The legislators will chart a cautious course and not erect a whole new agency at the same time they are overhauling the system.

With Wos having (coincidentally?) just stepped down as Secretary of the Department of Health and Human Services, perhaps the lack of a lightning rod for criticism of DHHS will let the air out of the proposal to remove Medicaid from DHHS’s hands.

Stay tuned.

By Robert Shaw

Robert

Passing the Torch: Wos Resigns!! Brajer Appointed!

Aldona Wos resigned today after two years and seven months as Secretary of NC DHHS.  Wos’ last day will be Aug. 14.

McCrory named Rick Brajer, a former medical technology executive, as the new Secretary of DHHS.

Soon-to-be Sec. Brajer, 54, was the chief executive of ProNerve and LipoScience.  LipoScience was sold to LabCorp in 2014, and ProNerve was sold to Specialty Care in April.

Brajer is not a doctor, as Wos was.  Instead, Brajer touts an MBA from Stanford.

I do not have any information as to why Wos resigned now, especially in light of the recent resignation of the Secretary of Transportation, but will keep you apprised.

More to come….

North Carolina Has a New Medicaid Director!!! Careful, It’s a Hot Seat!

Dr. Robin Gary Cummings was named the new state Medicaid director today.

Dr. Cummings, a former cardiovascular surgeon, had been serving as the Acting State Health Director.  He ceased pursuing surgery in 2004.

Interestingly, if you go the NC American Indian Health Board (found here), according to the website, Dr. Cummings is currently serving as the Medical Director for Community Care of the Sandhills. Obviously, Community Care of the Sandhills (CCS) is one of 14 non-profit organizations participating in the Community Care of NC (CCNC).   CCS is covers Medicaid for Harnett, Hoke, Lee, Montgomery, Moore, Richmond, and Scotland counties. 

However, when you go to CCS’ website, and click on “staff,” then, using the drop-down box, click on “leadership,” the Medical Director is Dr. William Stewart.  So, obviously, Dr. Cummings has served in the past as the Medical Director for CCS.

After a bit more research, it appears that Dr. Cummings left CCS this past July 2013, when Sec. Wos appointed Dr. Cummings as the Acting State Health Director in lieu of Dr. Laura Gerald’s resignation.  If you remember, Dr. Gerald’s resignation was unexpected and Sec. Wos gave no reason for Dr. Gerald’s resignation.  Sec. Wos announced that Dr. Cummings would be taking Dr. Gerald’s place the very same day that Sec. Wos announced the resignation of Dr. Gerald.

So my question is this:

Why was Dr. Gerald replaced immediately by Dr. Cummings as the Acting State Health Director, while Carol Steckel resigned back in September 2013 and is being replaced by Dr. Cummings 4 1/2 months after Steckel’s resignation?

We haven’t had a State Medicaid Director (officially) for 4 1/2 months.  Sandy Terrell stepped up as the temporary Medicaid Director.  And we know Sec. Wos and team has been actively searching for new Medicaid Director.

In fact, the February 11, 2014, agenda (today) for the Joint Legislative Oversight Committee on Health and Human Services shows as its 11th topic, “Ideas to Address Staffing Concerns and Update on Medicaid Director Search.”  Which tells me that there was little to no forewarning as to the appointment of Dr. Cummings.

Why?

It would be one thing if, after 4 1/2 months, Sec. Wos announced that the new State Medicaid Director was ____, someone from outside NC with excellent experience.  She didn’t want to announce that _____ was coming to NC prematurely because it was confidential and ____ did not want the public to know prior to a final decision.

But Cummings?

He has been working in NC Medicaid since 2004.  He has served as the Acting State Health Director.  Obviously, he was not hard to find.  Obviously, Sec. Wos had contact with Dr. Cummings way back in September 2013.  So why not appoint Dr. Cummings as the State Medicaid Director back in September 2013?  Why wait 4 1/2 months?  And announce his appointment the same day as the February 11, 2014, Joint Legislative Oversight Committee on Health and Human Services meeting?  It just seems odd…

Maybe he refused the appointment back in September 2013.  Maybe it took Sec. Wos 4 1/2  months to convince him to take the challenge.  Because, come on, folks, Dr. Cummings has just elected to place himself in one of the hottest public seats in the state…and I mean scorching!  Remember my blog: “Wanted: North Carolina Medical Director: Transparent and Open!”

Regardless the reason for the delay, it is encouraging that we have a new State Medicaid Director.  I am sure Dr. Cummings is fully aware of the current disarray of the NC Medicaid system.  So, even knowing the turmoil of our current Medicaid system and how daunting his task will be, Dr. Cummings still chose to accept the appointment to the State Medicaid Director position.  And, for that, I say “Bravo!”  And “Good luck!”  And “We really hope you are successful!”

But, gracious, that seat will be hot!

Former DHHS staffer takes jobs with Medicaid contractor

I cannot take credit for this blog.  I cut and pasted the test from WRAL.  But…WOW!!!!

Raleigh, N.C. — A state employee who helped oversee the construction and rollout of the NCTracks Medicaid billing system now works for Computer Sciences Corp., the contractor responsible for the troubled project. Paul Guthery was an IT manager at the Department of Health and Human Services, where he had worked since January 2010. At a hearing Wednesday, State Auditor Beth Wood described him as the agency’s “point person” for CSC, responsible for certifying NCTracks’ testing process. At least one good-government watchdog says his jump from supervising the company to working for it raises the appearance of a potential conflict of interest, one that the state should try to avoid in the future.

According to public records, Guthery began working for the state on Jan. 1, 2010. His last salary was $126,500 per year. He stopped working for the state Aug. 27 and soon after began working for CSC as an executive account executive.  Doctors, hospitals and others who render care for patients covered by Medicaid, the state-federal health insurance program for the poor and disabled, must use the CSC-built NCTracks system to get paid for those services. The system went live July 1 and soon after become the focus of controversy, with providers saying it was nearly impossible to submit claims and that payments were delayed by months. The delays threatened to drive some providers out of business and complicated care for thousands of patients.

Since then, the state and CSC have struggled to right the program. It was in late August, as providers bombarded lawmakers and the governor’s office with complaints about the system, that Guthery made the jump to the private sector.
Guthery declined via email to speak with WRAL News, deferring to his company’s corporate communications department. Michelle Sicola Herd, a spokeswoman for CSC, declined a request for an interview and was not willing to speak on the record about the circumstances of Guthery’s hiring.

Officials with DHHS downplayed Guthery’s part in the rollout of NCTracks, saying Thursday that he never occupied a position in which he would give the final word on the program going live. “One of the key things is that Paul was one of many people involved in this project, a very large project going on for a very long period of time,” said Ricky Diaz, a spkesman for the department.  Diaz emphasized that an outside testing group reviewed the stability of the NCTracks system before state officials turned it on July 1.

But Wood blasted the role of that third-party overseer, saying the company hired for independent verification and validation of system testing had not actually conducted any independent verification. Rather, they merely collected information from DHHS and CSC and summarized it in a report.

During a hearing Wednesday, Sen. Jeff Tarte, R-Mecklenburg, asked Wood who was responsible for signing off on reports that system testing had been completed and was successful.

“The agency,” Wood answered, adding, “The point person that was at the agency is now working for CSC.”  That person was Guthery. 

Diaz said state personnel laws prevent him from talking about what, if any, steps were taken to try to keep Guthery as an employee. But he emphasized that the state had taken strides to get the system on track, pointing out that it has been under construction for more than 10 years. 

“There have no doubt been challenges. This is a very large transition for the state of North Carolina,” he said. “The NCTracks project has, to date, paid $3.8 billion to North Carolina health care providers, as well as processing more than 78 million claims.”  With regard to Guthery, Diaz said state law does not currently prohibit employees who work with a contractor from taking a job with that contractor. By contrast, had Guthery taken a job as a lobbyist, he would have needed to wait six months before working with the legislature or his old employer. No such cooling-off period applies to employees in other lines of work. 

Jane Pinsky, with the North Carolina Coalition for Lobbying and Government Reform, says lawmakers should consider changing that.  “If I’m a skeptical, cynical citizen, the question is, did he (Guthery) give them a pass and then they gave him a job?” Pinsky said.  Earlier this year, another high-ranking DHHS staffer left for a private-sector job. Former state Medicaid director Carol Steckel was recruited to overhaul North Carolina’s system but left abruptly for a position with Wellpoint, a managed-care company based in Florida.

Pinsky pointed out that Wellpoint could end up bidding to run some or all of North Carolina’s Medicaid services under the McCrory administration’s planned reforms.
“In state government, and in DHHS, it is not unprecedented for employees to go work for vendors,” Diaz said. 

Asked if he thought the Guthery situation could be viewed as a conflict of interest, Diaz said DHHS was being “very transparent” with regard to the situation. Asked if the agency would put any policy changes in place, Diaz referred to DHHS Secretary Aldona Wos’ efforts to improve contracting practices more broadly.  “I think what you’ve seen is this secretary has placed a heavy emphasis on contract oversight and compliance,” he said.  But Pinsky says the problem could be addressed in other ways.  “One thing you can do is tell the contractor that, as a condition of the contract, they can’t hire anybody” in the agency, she said. She also suggested the possibility of a non-compete clause for employees hired to administer contracts.

In the meantime, she says, lawmakers should consider instituting a cooling-off period for high-level staffers.  “Anybody who oversees a contract or supervises an industry shouldn’t be able to go to work for them the next day,” she said. “Does that affect any decisions they’re going to make in how they administer the contract?”

Thomas Mills Writes: Wos Loss

I cannot take credit for this article, but it is important enough to post it.  Thomas Mills wrote as follows:

Well, if the rumors swirling around Raleigh are true, Aldona Wos, Secretary of Health and Human Services is gone. If so, it looks like the McCrory administration waited for a Friday afternoon news dump, hoping people are distracted by the weekend. Regardless, the political establishment will take notice and Pat McCrory, who has stood by the embattled Secretary, will have yet another black eye.

But if the rumors aren’t true, they sure should be. Wos has made a mess of the department. She never understood the role of an administrator. She ran off most of the professional staff and brought in political hacks and ideological soul mates with little or no experience in health, human services or administration.

Instead of taking responsibility for her actions or those of the department, she blamed other people. She avoided the press and at one time said she was opposed to transparency. Several times, Wos tried to alter the truth and when she was caught, never explained or apologized. In her appearance before the legislature, she left members of both parties unsatisfied with her answers.

And it doesn’t help that she comes off as arrogant, condescending and elitist. Not a good combination in politics.

But for all her problems, McCrory stood by Wos. Nobody in either party knows exactly why. Some people think it’s her money. Others say he has an intense personal loyalty. Still other say he’s scared of her.

Who knows. But her biggest sin was hanging her boss out to dry. When salary-gate broke, Wos wouldn’t respond to the press leaving McCrory to defend the indefensible. He lied to cover up her stupid hires, saying that the two campaign hacks beat out more experienced people for jobs when, in reality, nobody else was considered. He should have fired her then, but since he didn’t have the backbone, she should have stepped down. With each of her mistakes, McCrory came out to defend her even as his poll numbers sank.

The whole debacle has been a sorry episode. If she’s done, it’s McCrory’s second cabinet secretary to go in less than a year. We still don’t why Kieran Shanahan left, but there won’t be much question about Wos. She was inexperienced, incompetent, ideological and arrogant. She had no business there in the first place. And that is Pat McCrory’s fault.

Aldona Wos: New Head of DHHS

December 13, 2012, Governor-elect Pat McCrory appointed Aldona Wos as the new head of the Department of Health and Human Services (DHHS).

But who is she? Will she proceed differently than former head of DHHS Albert Delia?

Wos (pronounced Vosh) is a native of Poland.  She is a retired physician and, in 1997,   moved to Greensboro when her husband, Louis DeJoy,  set up a business there.  Wos” husband, Louis DeJoy, is Chief Executive Officer of New Breed Logistics, Inc., a privately held third-party logistics company founded in 1968 and headquartered in High Point, North Carolina.

Once Wos moved to NC, she became an avid Republican Party fund-raiser. She was appointed North Carolina State Chair of Women for Senator Elizabeth Dole.  For the 2004 Bush/Cheney presidential campaign, Wos served as the Carolina Finance Co-Chair.  President George W. Bush appointed her to two terms on the U.S. Holocaust Memorial Council, which was apropos, since Wos’ father was a Holocaust survivor.

From 2004-2006, Wos served as the Ambassador to Estonia.

According to http://www.CampaignMoney.com, in 2008, Wos donated $73,120 to the Republican party.

Does the fact that Wos contributed to the Republican Party for years and was appointed by a Republican governor mean that Wos is not qualified for the job?

I think not. Obviously, Wos is a retired-phyician.  She has the health care knowledge from the perspective of a physician. This could be a great thing! Hopefully she will have first-hand knowledge of the need for physicians to receive higher Medicaid reimbursements

Also, Wos is no Newby to politics. Her past political contributions and public service shows a great love for this country, which is not her native country.

I could not find much about Wos between 2006 and 2012 (her appointment as head of DHHS). There has been a lot of criticism of Wos due to her contributions to political campaigns.  But, I say, let’s see what she does. She is obviously educated in health care and savvy in politics…which makes her qualified without question as head of DHHS.

Look at former head of DHHS Albert Delia.  He was not a physician. Before he served at head of DHHS he was Gov. Purdue’s chief policy advisor and Senior Advisor. I was unable to find any positions Delia held prior to head of DHHS that would have made him uniquely qualified to head DHHS at all.  (Which is better? Being appointed because you were involved in the governor’s politics as a career? Or being appointed because you contributed to campaigns, but held your own medical degree?)

I’m not saying Wos is qualified merely because she is a physician.  I’m just saying let’s give her a chance because she does seem qualified, regardless of her campaign contributions. Plus, having someone who worked at a physician may have its benefits.  We will see…