Cost containment

In order for healthcare cost containment to work, you have to actually contain the cost.
New report from the State Auditor’s office shows how the state healthcare plan fumbled the overpayments to Bpatist Hospital. Via the report (pdf):

Using the combination of variables most closely aligned with the cost containment intent of the contract’s inflation adjustment provision, the estimated overpayment to Baptist Hospital for outpatient services is approximately $1.34 million, or 75% higher than the Plan’s calculation method.

Also, they didn’t even recover the lower amount.

This spells out what happened:

However, the State Health Plan did not have a plan for monitoring Baptist Hospital outpatient fee increases and determining if an inflation adjustment discount was allowed, and no one was assigned this responsibility. As a result, inflation adjustment analyses were not performed, and the discount rate was not increased during the entire contract period.
The State Health Plan should have sought fee increase information directly from Baptist Hospital as part of its contract monitoring plan. The National State Auditors Association “Best Practices in Contracting for Services” states, “Contract Monitoring is an essential part of the contracting process. Monitoring should ensure that contractors comply with contract terms, performance expectations are achieved, and any problems are identified and resolved. Without a sound monitoring process, the contracting agency does not have adequate assurance it receives what it contracts for.”
Because the State Health Plan did not monitor Baptist Hospital outpatient fee increases and did not increase the discount rate as allowed in the contract, the State Health Plan paid more to Baptist Hospital for outpatient services than it had to per the contract.

Auditor report shows excessive OT at State Fair

State Auditor Beth Wood released an investigative audit of overtime at the State Fair, which is managed by the Department of Agriculture. The report cites excessive overtime and off hours working.
The State Fair, as you may recall, has a rather checkered past. So, watch this latest development closely.

The report contains an interesting response to the Ag Department’s response to the report in which Wood calls the department’s response misleading.

The North Carolina Department of Agriculture and Consumer Services (Department) provided a response to our investigative report that we believe is misleading. While our report did not include a finding of fraud, it did include a finding of excessive and unjustified overtime hours. As noted in our report, overtime pay decreased from $23,143 to $14,698 over a four-year period after the Department hired an employee to assist the Facility Sales Director. However, the Department continued to pay for overtime even though the State Fair Manager said he was generally unaware of what the Facility Sales Director was working on outside of normal business hours.
The Department contends that the sales and marketing staff at the State Fairgrounds is significantly understaffed. However, in our opinion, the Department has no basis for this argument in the absence of a comprehensive evaluation of the Facility Sales Director’s work habits and relative efficiency. Thus, any increase in expenditures for staffing would be imprudent without performing this type of assessment.

State audit calls for tighter controls on Golden LEAF

State Auditor Beth Wood’s office just released a look at the practices and oversight of the Golden Long-term Economic Advancement Foundation – the state’s Golden LEAF fund – which was set up to utilize NC’s share of the tobacco settlement.
The audit cites the need for stricter oversight over investments and grants.
Here’s the link to the page o’ audits and the pdf link for the G-LEAF Audit

Questioning Turpike Authority

Rep. Crawford’s House Bill 1617 is up in the Senate today. The bill changes the way the state’s turnpike authority is set up. Under the bill the authority would be within the DOT and not a separate entity (with a hefty annual budget). If you’re interested, the fiscal note in this case is worth a read.
In part this is a cost savings measure, but it is also could represent a depoliticizing of the process. I’m sure the turnpike board is a great bunch of men (didn’t see any women last time I checked), but I’ve always felt this state could use a few less independent “authorities” stuffed with well-connected folks calling the shots.
Here’s the bill

The Long Struggle

Via the White House:

. . . The American people are the most insurance-minded people in the world. They will not be frightened off from health insurance because some people have misnamed it “socialized medicine”.
I repeat–what I am recommending is not socialized medicine.
Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.
Under the plan I suggest, our people would continue to get medical and hospital services just as they do now–on the basis of their own voluntary decisions and choices. Our doctors and hospitals would continue to deal with disease with the same professional freedom as now. There would, however, be this all-important difference: whether or not patients get the services they need would not depend on how much they can afford to pay at the time.
I am in favor of the broadest possible coverage for this insurance system. I believe that all persons who work for a living and their dependents should be covered under such an insurance plan. This would include wage and salary earners, those in business for themselves, professional persons, farmers, agricultural labor, domestic employees, government employees and employees of non-profit institutions and their families.
In addition, needy persons and other groups should be covered through appropriate premiums paid for them by public agencies. Increased Federal funds should also be made available by the Congress under the public assistance programs to reimburse the States for part of such premiums, as well as for direct expenditures made by the States in paying for medical services provided by doctors, hospitals and other agencies to needy persons.
Premiums for present social insurance benefits are calculated on the first $3,000 of earnings in a year. It might be well to have all such premiums, including those for health, calculated on a somewhat higher amount such as $3,600.
A broad program of prepayment for medical care would need total amounts approximately equal to 4% of such earnings. The people of the United States have been spending, on the average, nearly this percentage of their incomes for sickness care. How much of the total fund should come from the insurance premiums and how much from general revenues is a matter for the Congress to decide.
The plan which I have suggested would be sufficient to pay most doctors more than the best they have received in peacetime years. The payments of the doctors’ bills would be guaranteed, and the doctors would be spared the annoyance and uncertainty of collecting fees from individual patients. The same assurance would apply to hospitals, dentists and nurses for the services they render.
Federal aid in the construction of hospitals will be futile unless there is current purchasing power so that people can use these hospitals. Doctors cannot be drawn to sections which need them without some assurance that they can make a living. Only a nation-wide spreading of sickness costs can supply such sections with sure and sufficient purchasing power to maintain enough physicians and hospitals.
We are a rich nation and can afford many things. But ill-health which can be prevented or cured is one thing we cannot afford.

Harry S. Truman, Special Message to Congress Recommending a Comprehensive Health Program, Nov. 19, 1945

Prevent Racial Profiling

Senate Bill 464 — prevent racial profiling — is going to get a review by the House Juvenile Justice Judiciary Committee this week. (Remember the incidents in Alamance? )
Here’s the text:


AN ACT to amend the law requiring the collection of traffic law enforcement statistics in order to prevent racial profiling and to provide for the care of minor children when present at the arrest of certain adults.

The General Assembly of North Carolina enacts:

SECTION 1. G.S. 114‑10.01 reads as rewritten:

“§ 114‑10.01. Collection of traffic law enforcement statistics.

(a) In addition to the duties set forth in G.S. 114‑10, the Division of Criminal Statistics shall collect, correlate, and maintain the following information regarding traffic law enforcement by law enforcement officers:

(1) The number of drivers stopped for routine traffic enforcement by law enforcement officers, the officer making each stop, the date each stop was made, the agency of the officer making each stop, and whether or not a citation or warning was issued.

(2) Identifying characteristics of the drivers stopped, including the race or ethnicity, approximate age, and gender.

(3) The alleged traffic violation that led to the stop.

(4) Whether a search was instituted as a result of the stop.

(5) Whether the vehicle, personal effects, driver, or passenger or passengers were searched, and the race or ethnicity, approximate age, and gender of each person searched.

(6) Whether the search was conducted pursuant to consent, probable cause, or reasonable suspicion to suspect a crime, including the basis for the request for consent, or the circumstances establishing probable cause or reasonable suspicion.

(7) Whether any contraband was found and the type and amount of any such contraband.

(8) Whether any written citation or any oral or written warning was issued as a result of the stop.

(9) Whether an arrest was made as a result of either the stop or the search.

(10) Whether any property was seized, with a description of that property.

(11) Whether the officers making the stop encountered any physical resistance from the driver or passenger or passengers.

(12) Whether the officers making the stop engaged in the use of force against the driver, passenger, or passengers for any reason.

(13) Whether any injuries resulted from the stop.

(14) Whether the circumstances surrounding the stop were the subject of any investigation, and the results of that investigation.

(15) The geographic location of the stop; if the officer making the stop is a member of the State Highway Patrol, the location shall be the Highway Patrol District in which the stop was made; for all other law enforcement officers, the location shall be the city or county in which the stop was made.

(b) For purposes of this section, “law enforcement officer” means any of the following:

(1) All State law enforcement officers.

(2) Law enforcement officers employed by county sheriffs or county police departments.

(3) Law enforcement officers employed by police departments in municipalities with a population of 10,000 or more persons.

(4) Law enforcement officers employed by police departments in municipalities employing five or more full‑time sworn officers for every 1,000 in population, as calculated by the Division for the calendar year in which the stop was made.

(c) The information required by this section need not be collected in connection with impaired driving checks under G.S. 20‑16.3A or other types of roadblocks, vehicle checks, or checkpoints that are consistent with the laws of this State and with the State and federal constitutions, except when those stops result in a warning, search, seizure, arrest, or any of the other activity described in subdivisions (4) through (14) of subsection (a) of this section.

(d) The identity of the law enforcement officer making the stop required by subdivision (1) of subsection (a) of this section may be accomplished by assigning Each law enforcement officer making a stop covered by subdivision (1) of subsection (a) of this section shall be assigned an anonymous identification numbers to each officer in an number by the officer’s employing agency. The anonymous identifying number shall be public record and shall be reported to the Division to be correlated along with the data collected under subsection (a) of this section. The correlation between the identification numbers and the names of the officers shall not be a public record, and shall not be disclosed by the agency except when required by order of a court of competent jurisdiction to resolve a claim or defense properly before the court.

(d1) Any agency subject to the requirements of this section shall submit information collected under subsection (a) of this section to the Division within 30 days of the close of each month. Any agency that does not submit the information as required by this subsection shall be ineligible to apply for any law enforcement grants available by or through the State until the information which is reasonably available is submitted.

(e) The Division shall publish and distribute by December 1 of each year a list indicating the law enforcement officers that will be subject to the provisions of this section during the calendar year commencing on the following January 1.”

SECTION 2. G.S. 15A‑401 is amended by adding a new subsection to read:

“(g) Care of Minor Children. — When a law enforcement officer arrests an adult who is supervising minor children who are present at the time of the arrest, the minor children must be placed with a responsible adult approved by a parent or guardian of the minor children. If it is not possible to place the minor children with a responsible adult approved by a parent or guardian within a reasonable period of time, the law enforcement officer shall contact the county department of social services.”

SECTION 3. This act becomes effective January 1, 2010.