“Tragedy of errors” | Quigley stakeholdering budget | SeaMar pushing back on AG penalty

We are gearing up for our fall conference season, where we host our Inland Northwest event on Sept 10th.  That’s followed closely by our Portland (9/24) and Anchorage (10/9) events, making for a busy time.

But as those conference agendas come together, if you have ideas for speakers or content, send me a note.  I’d love to hear about them, forward them to our Convening Panels, and see if we can plug your ideas in to our discussions.

1. Our Spokane event Convening Panel meets next week

Our events are extremely stakeholder-driven.  It’s a process we’re careful to cultivate so that folks feel like they have an opportunity to engage in the planning and development of the conference, as well as the content development and speaking roles.

That process starts with our Convening Panel, which for our Inland Northwest event on Sept 10th (right around the corner), includes a tremendously strong group of folks.

Expect our Topical Agenda to be out 8 weeks prior to our event, the second week of July.

2. A Tragedy of Errors

The news that the OIC Administrative Law Judge accidentally leaked her own whistle blower documents is drawing unbridled criticism from a number of insurance folks we’ve heard from.  A particular comment:  disdain that Judge Petersen let the poor Office Depot employee who served her as she mailed to documents be deposed under oath before she had the courage to come clean.

This is becoming a tragedy of errors with negative impacts for everyone – including the marketplace of plans and providers who want to see politics and drama no where near regulator bodies.  With a hearing next week in the Senate to highlight this debacle, things are likely to get worse before they get better.

3. The Everett Clinic leads on price transparency

The Adult Behavioral Health System Task Force meets this week. Their charge includes determining regions for Medicaid procurement in 2015.  This new regional approach to procurement will mean an end to the county-by-county model of procurement.  It may also mean that rural providers with referral patterns that cross regional procurement areas will see some challenges in working with plans who may cover a patient living in a region different from the one where the provider is located.

It’s a little in the weeds, admittedly.  So, you probably don’t have to worry about it – unless you are a Medicaid plan…  Or a provider who takes Medicaid…  Or a Medicaid beneficiary.

4. Quigley drawing praise for frank talk ahead of budget

DSHS Sec. Quigley is leading a stakeholder engagement initiative to think through the development of the 2015-2017 DSHS budget.  It’s a level of engagement and transparency in budgeting that seldom occurs in state government in this way, this early in the process, and especially at DSHS.

Moreover, he’s getting credit from many for being honest about the gap between WA’s self perception and the programmatic reality at the state level.  He writes:

“Whilst we long term Washingtonians (and you happy transplants) like to view our state as a progressive place that invests in our social programs alongside the most innovative states, years of long decline in revenue collections have moved Washington from the top tier in revenue collection to the bottom half. With all due respect to Mississippians, when our state comes to rank two places below Mississippi in revenue collection it is impossible for our social service system to sustain itself.”

5. SeaMar Fine Equal to Almost Half Its Annual Revenue

The story about SeaMar being fined $72 million by the Attorney General for $7 million in allegedly fraudulent claims seems like kind of a big deal.  It’s a relatively big number for any provider to have to grapple with – in this case about half of their $160m annual budget.  Simply the question of “how” SeaMar will pay the fine is a question – though it should be noted they are appealing the AG’s determination.

It also raises a question about whether this represents a new level of activism by the state to audit and review medical (or dental in this case) claims.  Indeed, AG Bob Ferguson lists 7 actions related to Medicaid fraud on his “News” site for 2014 alone.  SeaMar’s action wasn’t included there.