A most revealing episode at the legislature yesterday as discussed in an Arkansas Democrat-Gazette article this morning. (Pay wall.)
Republicans continued to express skepticism about the state Medicaid program’s plan to shift to a reimbursement plan based on episodes of care and successful treatment, rather than a straight fee-for-services system. Two Republican doctors’ wives in the state Senate, Cecile Bledsoe and Missy Irvin are not happy. The state might reduce costs — and effectively expand access to care — by steering business to physician assistants rather than doctors.
“If you have physicians out in the state who don’t want to do this, they’ll have nowhere to go,” said Cecile Bledsoe, R-Rogers, and chairman of the Senate Public Health, Welfare and Labor Committee. “I’m just not comfortable with that.”
And then there was Irvin, the senator from Mountain View whose air of entitlement has begun to rankle even some of her Republican colleagues.
“If every single payer is going to cut [doctors] to the bone when they could have just been a nurse practitioner, when they’re going to replace them all with nurse practitioners anyway, why would you go to medical school? Why go through all that training? And the patients at the end of the day, we suffer,” Irvin said.
“We” suffer. Somehow, I don’t think that “royal we” refers only to patients.
Bottom line: These Republicans oppose this system — not to mention the expansion of Medicaid in general. They’d rather serve fewer people under a system that pays doctors more than serve more people in a system that might save Arkansas taxpayers money.
The same meeting including some beefing about the high cost of the expensive worldwide consulting firm, McKinsey and Co., in advising DHS on its restructuring. Approval of a new $12.4 million contract was delayed.
Heck, no problem for DHS there to win over Republicans. Just call in U.S. Rep. Tom Cotton to testify. He was a high-dollar McKinsey consultant in Washington until the Club for Growth dispatched him to hold down a 4th District seat in Congress until he could run for Senate next year. Surely he’ll testify to the efficacy of spending millions with McKinsey.
I’d been looking into the McKinsey deal after hearing they’d had employees on the ground in Little Rock for months and also heard that Arkansas had emerged as one of the firm’s biggest public clients. I was interested because a couple of my relatives have worked for McKinsey in years past and many Little Rock natives toil for them around the globe. The firm has earned its reputation, but it is not known as a low-cost operator.
That $12.4 million new contract is on top of $28 million paid McKinsey over two years from a variety of Arkansas sources. The state contends the money is paying for itself in savings. Here’s what DHS spokeswoman Amy Webb told me when I inquired earlier: