Travis County Commssioners Court
September 30, 2003
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Item 32
Number 32, consider and take appropriate action on request for contract with the daughters of charity health services of Austin for Travis County medical assistance program, payment method would change from fee to service for cap taeugs payment.
>> essentially this is a contract we have with seton and have had with seton for several years. The major piece in this is that we're changing the payment methodology. Before we had been using a fee. We're going to capitate it. We are able to actually put a cap on liabilities. For example, before with with the fee for service methodology, if we had a catastrophic case, a situation we would actually be reimbursing them on a fee for service basis. In this case we just pay a certain rate given the number of individuals that are enrolled in the medical assistance program. We are able to save a few hundred thousand -- we project a cost abortance of a couple hundred thousand dollars using this methodology.
>> so it's a good deal for Travis County.
>> yes.
>> because for any particular individual, and I guess service, there is a limit of what we will be charged?
>> yes.
>> and so in the end, if we -- we may save a certain -- spend a certain amount of money, but we ought to get more clients served and services.
>> yes, we should get more services. The limit is based on the number of people enrolled in the medical assistance program.
>> and when will we make the comparison so we will know this is a good deal? Better than it has been. And who will make it?
>> actually we could make it on a -- I was going to say a monthly basis, but that wouldn't actually show as much. We could probably look at it at about a half year and certainly at the end of the year we'll do a cost comparison.
>> can we do it quarterly? I would think we would want to see --
>> we could, but we're going to be paying on a fixed rate according to the number of people that we have enrolled in the program. Actually we can do it. I change that. The reason that we can do it, we could get information regarding individual's conditions and what it could have cost us. We could do it, we can bring the information out to the first quarter.
>> on the surface, this makes all the sense in the world and it really should put us in a more advantageous position. In the end, we need to know what the facts are to concern the good feeling that we have now.
>> well, it's more than a good feeling because we can look at the --
>> good feeling the county judge has then.
>> a good feeling the county judge has. Well, actually, we have been tracking -- we have been doing comparisons all along. For instance, as we get bills in and we look at the end of the year, we look at what we would have paid using a capitated rate. You've seen evidence of that sometimes when i've done projections regarding our budget related to our map. Sometimes that cost looks a little higher, but what you don't see is the cap liability that you have with the capitated rate.
>> what other things do we expect from this, judge? Do we expect to see prevention of disease? Do we expect to see -- I mean are there other things other than just the cost or, you know?
>> basically we're purchasing hospital and specialty care through this contract. And that is the service that we're buying. Primary care, which also involves some preventive strategies, is -- we pay for that through our contract with the clinic system and the fqhc. But this is a hospital services contract. This is for those individuals that are enrolled in the medical assistance program that are needing hospital services as well as specialty care.
>> this is a money deal for us. Isn't it? In other words, you get the same service right now. What we can be charged is unlimited.
>> yes.
>> with this in place, there's a limit what we can be charged for a particular client.
>> yeah. That's what I'm hearing.
>> and the change here is instead of the costs being unlimited, it would be capped at a certain amount.
>> right.
>> but is that all we want to know about this? Just that the cost is capped? But do we want to know what other things we get? Like are people healthier next year?
>> well, you know --
>> I think this contract changes the amount. Now, there are other things I think that we ought to factor in, consider, address.
>> yeah, when you want to answer that question, you have to look at the continuum of services that are offered to individuals.
>> but is that information that you would keep, that you also look at besides the cost and cap?
>> and the medical -- in the medical assistance program, yes, there is a component that actually looks at -- they are disease management programs. Yes, we have something that looks at actual health of people. But I don't want to exaggerate what we're doing here. Basically what you are doing is continuing a contract with seton for hospital based services that our m.a.p. People receive. We are changing the payment not odd ology from a -- methodology. We are changing from a fee for services to a capitated rated. We will have better control over what we spend using a capitated methodology versus a fee for services. Because once I look at the enrollment, I can tell what you we're going to spend on hospital-related services. And if you ask me to reduce hospital-related service costs, we would cap enrollment, and that would be the simplest way to control costs.
>> maybe I can meet with you to see what we mean by hospital services.
>> okay. E.r. Specialty care.
>> what specialty care?
>> doctors.
>> just a couple questions. When you say "e.r.," Let's say one of our m.a.p. Patients inappropriately makes their way to the e.r. As opposed to some other way. This is covered thaupbd?
>> yes.
>> -- covered under that?
>> yes.
>> it's emergency care, planned, unplanned, inappropriate. If they walk through the door at brackenridge hospital, this is covered. Okay. Second question, did you roll the idea of the capitated rated -- rate into your budget projections this year?
>> yes.
>> the final thing, does the city of Austin have a capitated rate for its m.a.p. Patients?
>> they've had one for he several years.
>> and what is that number in comparison to our number?
>> actually I don't know that number.
>> do we this think it's the same or our capitated rate is the higher?
>> actually I'm not sure. I haven't looked at that.
>> is that a relevant question that is correct whether we got the same deal that is being offered the city of Austin?
>> only to a point because the way this figures, the capitated rate is based on the degree of illnesses of the enrollees. That's one of the factors.
>> see, that's why it was important for me to see what is it that we're dealing with. Do we know, other than the costs, because what if we're not -- what if people are not getting better?
>> if they are not getting better through this contract, they weren't getting better a month ago or six months ago.
>> are they more ill, if they live in the county, versus if they live in the city of Austin. And there's just a little bit more data that I'm curious about than just the cost. If it's going to be cost, that's just a budgetary amount that we budget every year. But what is the impact of that money on people's health through this process? That I'm curious about.
>> we can sit down and i'll go into a more indepth discussion.
>> okay.
>> because this really is a purchase of services contract.
>> yeah, I understand that.
>> the question that you all are asking relative to morbidity rates and whatever, we would have to go into a more indepth discussion. And also, there -- it's a lot more involved when you start to look at that.
>> yes.
>> I do want the information, though, please, related to what is the city of Austin's capitated rate and how it compares to this capitated rate. The final question i've got related to the capitated because this is a huge initial the private sector, what we're seeing in terms of capitation rate the government is giving, that rate is coming down and forcing cost savings, efficiencies, et cetera to occur. It's also causing a great deal of frustration in terms of what you can and can't do. I'm just wondering because this seems to be a capitation rate that is going up based on inflationary figures, and it's just the opposite of what is happening to our physicians. They are seeing the capitation rate drop, forcing them, sometimes good, sometimes not good, in terms of how to schedule, how to be more effective in terms of the use of their time, et cetera. So I'm wondering why we would be locking in on a capitation rate that is just the opposite of what those in the private sector are dealing with on the receiving end of government.
>> actually I don't know the answer to that. I do know that the same inflationary factor is used with the city of Austin contract, which they've had with them for several years.
>> I'm sorry, this really is my final question. Are we going to be able to review this, say, in another year to see if it met the expectations we had hoped to get?
>> yes.
>> so we're not locked into something forever and ever.
>> no.
>> okay.
>> we're going to get quarterly reports.
>> we can give quarterly reports. But I do want to say this. This is a better deal than we had before, though. It's a much better deal. We had no control on hospital-based services and specialty care on a month to month basis because it wasn't locked into enrollment. We paid on a fee for service basis. With this, we have more budgetary control. I think the issues related to morbidity rates and whatever is a good one, but I think that it requires, you know, another meeting and where we can get more into that. Because this is not a prevention contract. This is hospital-based service, specialty care contract.
>> steven, do you know whether or not the e.r. Activities that are going on at brackenridge and the folks that serve through that who are not clients, is that something that has been tracked to see if they may could have used something? You know, I don't know the severity of -- them coming in and maybe there could have been something done at the rural clinic settings as opposed to going to the e.r., Maybe the after-hours situation. I really don't know all the levels of entry as far as e.r., Just going to brackenridge. I don't know how that normally works.
>> actually that data is tracked. Because that is how we have historically paid this contract, on a fee for service basis. So it would be on a per-visit basis or stay basis to the hospital. So we have that information.
>> okay.
>> I move approval.
>> motion by Commissioner Gomez.
>> I second that motion.
>> seconded by Commissioner Davis. So have we worked -- the invoice that we get under this contract would be a little different than invoices we've gotten in the past.
>> it should be, yes.
>> but if we work with the auditor to -- are we in agreement, I guess, on the [inaudible] invoice?
>> [no microphone on]
>> no, it's just that I think we need to get together on that so it won't be --
>> in accordance with how we're doing it. We're not dealing with this nine months after the fact how we're going to validate the invoices.
>> okay. Any more discussion in all in favor say aye? That passes by unanimous vote.
>> thank you.
>> was there a friendly included related to the quarterly reports?
>> yes. Yes.
>> and i'll accept that.
Last Modified: Tuesday, September 30, 2003 7:52 PM