Last week, I got to do something I enjoy very much: saying “I told you so.” I am paying for that this week because I have to do something of which I am much less fond: admitting that I was wrong about an important subject.
For years, as we have debated an increased government role in providing medical care, I have cited the health care provided by the Department of Veterans Affairs as an example of how the government can do that very well.
My argument was very strongly empirically based. I was reporting the virtually unanimous sentiments expressed by veterans served by the VA. In fact, on those occasions when the federal government was considering changes in the delivery of medical care, I heard very firmly from veterans that they did not wish there to be any change in the system that serves them, and they did not want to be folded into other health care systems.
A combination of factors attracted them so strongly to this system. One was the sense of solidarity that veterans got – particularly older ones, who, when hospitalized, could spend time with people who had shared important experiences in their earlier lives, even if they were not direct comrades.
But there was also a clear perception, supported by evidence, that the care itself was first rate – as it should be – because the VA pioneered medical care in areas particularly relevant to those who had received the kind of wounds that one gets in combat.

Maine Cancels Contract with Alexander Group

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From the day it was announced that the state's nearly $1 million contract with the Alexander Group to study Maine's welfare system has been under fire. Six months later, reports of inaccurate projections and allegations of plagiarism increased the volume on Demcrats' calls for terminating the contract. Now Republican Gov. Paul LePage has done just that - but the state is still out more than $400,000 dollars.
Gov. Paul LePage said the state of Maine and the Alexander Group had gone about as far as the two could go in a problematic contract that the governor terminated this afternoon. The $925,000 state Medicaid study had been lambasted by critics for containing major math errors and portions of analysis that were extrapolated from other unattributed sources.
LePage imposed penalties that allows the Department of Health and Human Services to retain $450,400 in funds formerly allocated to the consultant.  Still LePage signed off on an agreement that allows Alexander to keep about $475,000 already paid to him by Maine taxpayers.
"There are two things to look at," LePage said. "The text and teh attributions that they failed to do and then it's the content."
The governor said the state got its money's worth from the Alexander report.
"And frankly when you read it, I agree they didn't give the proper attributions, but I didn't find any errors in the content of the information," LePage says, "and we got what we paid for, basically. Probably more, in some respects."
"I think there's a lot of state money that could have been saved," said state Rep. Drew Gattine.
Gattine is a Westbrook Democrat on the Legislature's Health and Human Services Committee who has been leading the assault on LePage's no-bid contract with the Alexander Group since it was announced in December.
"I don't really see any value that this has brought to any of the important conversations that we need to have in this state about what we're going to do about our public assistance programs," he says.
http://news.mpbn.net/post/maine-cancels-contract-alexander-group

Posted June 16, 2014, at 12:27 p.m.
Gov. Paul LePage’s administration has finally given into reality.
On Thursday, the state Department of Health and Human Services finally canceled its $925,000, no-bid contract with the Alexander Group, the discredited consultancy that produced two ideology-driven documents opposing an expansion of Medicaid and promoting LePage’s favored welfare “reforms.”
Five months after it became obvious that the consulting firm led by Gary Alexander had turned out exceptionally shoddy work, the LePage administration finally made the right — albeit well overdue — move in cutting off its relationship with the organization.
We’re pleased that the Alexander Group will produce no additional work for the state and will see no further payment from Maine taxpayers. The firm will even have to pay a $27,000 penalty.
The cancellation of the firm’s contract, however, does not make this episode right. The Alexander Group will still record $475,000 in income when all is said and done, including $236,000 in federal funds that have been potentially misused. And it’s disturbing that the Department of Health and Human Services determined there was some redeeming value in the work produced by Alexander.
Even disregarding the fact that the Alexander Group plagiarized much of its work from credible sources, we have failed from the start to see any value in the firm’s work.
The group’s first report, supposedly a study of the feasibility of expanding Maine’s Medicaid program under the Affordable Care Act, fell far short of actually determining the feasibility of expanding Medicaid. The consultants calculated only the cost of expansion using a suspect methodology that inflated the final price tag — one of the group’s calculations was $575 million too high, the result of a math error — without considering any effects that offset the cost. It was a document grounded in ideology rather than the analysis the state needed.
In a January interview, Alexander and colleague Eric Randolph explained away many of the report’s shortcomings — a lack of analysis of Medicaid expansion’s economic impact, for example, or a failure to consider the net financial benefit to Maine’s hospitals — by saying it was too difficult to include those factors in the analysis.
The group’s second report recommended changes that LePage himself had already proposed for Maine’s welfare programs and the Legislature had already rejected. The document, which was submitted five months after its deadline, lacked sound reasoning to back up its suggestions.
LePage last week blamed a poorly written contract for the Alexander Group debacle. But this episode is about more than a poorly written contract, and it’s not about a failed state contracting process. The overriding flaw was the LePage administration’s decision to seek this work in the first place.

Maine Hospital's Dilemma: Improved Care Shrinks Bottom Line

Under the Affordable Care Act, the quality of health care you receive is supposed to improve. Hospitals, for example, are expected to reduce readmissions, cut down on unnecessary tests. But these are the kinds of services that have been the bread and butter of hospitals for years. Take them away, and the hospital loses money. So the challenge for hospitals is how to increase quality and still stay in business. Patty Wight visited one hospital in western Maine that's grappling with that task, and tonight she has the first of two reports on what she found out.
Patty Wight reports on Franklin Memorial Hospital.
In her 30 years of nursing at Franklin Memorial Hospital in Farmington, Tracy Harty has sported about a dozen different ID badges. "I'm currently a nurse navigator," she says.
As a navigator, part of Harty's job is to usher uninsured patients through the health system. On this day, she's checking on Mark Osgood, who is at the hospital because of a recent lung cancer diagnosis. "Your first treatment is Thursday morning," she says. "And, are you coming alone?"
Before his diagnosis, Osgood didn't have health insurance, so Harty helped him enroll. She'll keep helping him - with paperwork, or getting whatever community resources he needs. 
Osgood says it's a relief.  He can focus on getting better. "I need help," he says. "I mean, this is a desperate fight. I can't do this by myself.  I know I can't."
Last year the hospital spent more than $6 million providing care for the uninsured. Franklin County is the third poorest  in the state.  Charity care costs here are swelling.
So the hospital put Harty to work as a navigator to figure out what kinds of diseases were going untreated, to reduce costs by enrolling patients in insurance plans when possible, and to help patients take better care of themselves.


Maine Hospital's Dilemma: Improved Care Shrinks Bottom Line, Part II

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When a hospital increases the quality of its care, patients are healthier and need fewer services. While that's good for patients, hospitals lose money. It's created a conundrum for hospitals such as Franklin Memorial in Farmington, which serves as the financial underpinning of the community's entire health network. Patty Wight brings us the second of two reports on how the hospital is working to keep in line with expectations under the Affordable Care Act and still remain financially afloat.
Patty Wight reports on the Affordable Care Act.
Franklin Memorial Hospital made a push to improve quality even before the Affordable Care Act. Tests and procedures were scrutinized and the hospital changed its world view. Instead of touting successes, it worked on eliminating failures. And, it also encouraged patients to use preventative, primary care. With passage of the ACA, these changes were expedited. And Clinical Director Mavis Dubord says some staff began to worry. She remembers a nurse manager approached her one day and said, "I think you're moving too fast. Do you realize what this is doing to the finances of the hospital?"
It was a fair question, says Dubord. Each unnecessary ER visit the hospital prevented, each readmission avoided, each superfluous test or procedure the hospital stopped, was one less source of revenue. Revenue that was needed to support its efforts on quality.
"So this is the challenge," she says. "You have all those initiatives going on that really take more staff, that we're not adding. And at the same time you're pulling patients away from the hospital, which is where we make our money."
Over the past three years, the hospital's operating revenue dropped nearly $17 million. Chief Operating Officer Jerry Cayer says this loss extends beyond the hospital — Franklin Memorial is the engine that helps the rest of the county's health network run. The hospital supports programs from community mental health care to an ambulance service to primary care.


Wealth gap also skews charitable giving

Universities and hospitals win big support from the wealthy while social services struggle.

BY DAVID CRARY THE ASSOCIATED PRES