NC Tracks problems reflect lapses in leadership

Editorial by News and Observer, November 21, 2013.

Dr. Aldona Wos, secretary of the state Department of Health and Human Services, told a General Assembly health oversight committee Tuesday something that encapsulates how basic the problems are in her department.

“I continue to stress to our team, and our vendor, that we must get providers paid for the work they do,” she said.

Pay people for the work they do. That seems fundamental and yet for DHHS it’s a goal the secretary must stress and one not yet fully accomplished.

The issue is payments to some 70,000 Medicaid providers who have had their payments delayed or claims rejected under a new computer system – NCTracks. Wos launched the new system on July 1. More than four months later, prompt payments are still a problem. Wos says the system is getting better, but lawmakers should ask for a full accounting. They would also do well to hear from a cross-section of providers.

Progress questioned

Senate Minority Leader Martin Nesbitt, an Asheville Democrat, looked over charts provided by DHHS and said he couldn’t see any progress. “From these numbers and what I’m hearing here, I don’t think we’re fixing the problem,” he said.

DHHS statistics show NCTracks is still not functioning well. For the week of Nov. 1, NCTracks was approving claims from doctors offices at a rate of nearly 66 percent compared with 78 percent under the old system. Thirteen percent of dental claims were not approved compared to 3 percent not approved by the old system.

This prolonged period of slow payments and rejected claims is more than a matter of inconvenience. Some providers have had to borrow to meet payrolls. More significantly, some are getting fed up and getting out of the provider network. Fewer professionals willing to serve the 1.6 million poor children, older and disabled adults and low-income pregnant women enrolled in Medicaid could do lasting damage to the quality of their care and their access to it.

Meanwhile, the delays and confusion over Medicaid payments are making it hard for the General Assembly’s fiscal analysts to project the annual cost of Medicaid and whether the state should brace for costs beyond the $3.5 billion budgeted for the state’s share of the program.

Launched without backup

What is particularly galling about the NCTracks mess is it was unnecessary. There was no urgency to launch the new system on July 1, especially after the state auditor raised flags about whether it had been properly tested. Yet Wos and the McCrory administration went ahead for a penny-wise-pound-foolish reason: to avoid the cost of paying for the old system and the new system at the same time.

So the state saved money and Medicaid providers paid dearly in lost compensation, uncertainty and frustration.

What Wos should have told lawmakers wasn’t that she’s pressing DHHS staff and its computer vendor to pay people who are owed. She should have said, “We thought we were being frugal and instead we were reckless and it has cost everyone a great deal. I take responsibility. I apologize. And I’m determined to keep learning from my mistakes to fulfill the mission of my department.”

Instead, she told the committee, “I assure you that where necessary, I will hold people accountable.”

Excepting herself, of course.

Surprising endurance

Perhaps the most striking part of Wos’ appearance before the committee wasn’t what she said, but that she was there. It’s a wonder that she is still in charge of a $17 billion department with more than 17,000 employees given her repeated missteps in hiring and firing staff and the self-induced fiasco of NCTracks. Wos did not have experience as a manager of such a large bureaucracy and a system as complex as Medicaid that handles state Medicaid claims of $12 billion annually.

In staying on, Wos’ chutzpa and perseverance are impressive, particularly since she’s doing the job for $1 a year. But the price of her remaining at the helm is costing taxpayers in ways yet to be fully revealed.