Health

Tuesday, Apr 16 2013 06:05 PM

LOIS HENRY: There was no need for the MCS mess to drag on

By LOIS HENRY, Californian columnist lhenry@bakersfield.com

DUUHHHHHH! Of COURSE the county needed to get out of its contract with Managed Care Systems (MCS).

Of COURSE there was a conflict of interest.

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Lois Henry hosts "First Look with Scott Cox" every Wednesday on KERN 1180 AM from 9 to 10 a.m. The show is also broadcast live on www.bakersfield.com. You can get your two cents in by calling 842-KERN.

Supervisors wasted so much time and created so much drama around this no-brainer of an issue, I can't even give them a golf clap for finally doing the right thing on Tuesday (see news story, page 3).

The sanest voice in the din was that of Supervisor Mick Gleason, who called a spade a spade on the conflict issue.

He also rightly said county staff needs to do a much better job preparing information and presenting it clearly to supervisors.

And, most importantly, he and Supervisor Zack Scrivner both alluded to the need for a larger policy on what is and what isn't considered a conflict when the county contracts with private companies.

The public needs to trust that the county is playing fair with all sides, they said.

Actually, I agree on all counts.

To catch you up, in 2009, the county contracted with MCS to operate as the administrator of its main employee health care contract. That means MCS tracks and pays claims, manages how services are used and negotiates rates with doctors, specialty providers and hospitals.

Here's the problem: MCS is owned by GEMCare, which is partly owned by a group of local doctors. GEMCare, in turn, is 50-percent owned by Dignity Health. Dignity owns or controls both Mercy hospitals and Bakersfield Memorial Hospital.

All of which means MCS is in a position to negotiate rates with itself and steer patients to its own doctors and its own hospitals.

MCS has a clear monetary interest in seeing patients go to GEMCare docs and Dignity hospitals.

And that's a conflict. Plain and simple.

Even if MCS never acted on that monetary interest, it would still be a conflict, as Gleason noted Tuesday, because it would always be a risk.

He didn't believe there was any proof MCS had given in to that pull, but I'm not so sure.

The county's health care consultant, the Segal Group, did a report that showed a shift of patients to Dignity hospitals during MCS' administration. (A report the county tried, illegally, to keep from public view, by the by.) The report didn't say why the shift happened, it just laid out the numbers.

I chronicled the stories of several county employees who say GEMCare tried to hijack them to Dignity hospitals even though they prefered to go to San Joaquin Hospital or Bakersfield Heart Hospital, respectively.

And in the course of this whole melee, GEMCare/Dignity admitted there were some "rogue" doctors who misrouted county patients away from other service providers to keep them in the Dignity family.

Either way, the whole thing should have been dealt with years ago when Dignity first merged with GEMCare in 2009 a few months after MCS got the contract.

Dignity's competitors brought it to the county's attention right away. And the county could have easily given the contract to the runner-up bidder.

But no. As is the Kern County way, the mess was left to fester.

When it all finally broke open over the last few months, it was ugly and it didn't get prettier on Tuesday.

Supervisor David Couch's frustration was evident as he sought more information on fees for out-of-county claims. He felt he wasn't getting the full picture on costs by bidder Zenith American.

When Deputy County Administrative Officer Susan Wells tried to explain. People in the audience reacted and Couch cut them off.

"I was very respectful when you spoke and I would ask that you be as respectful when I speak, or my colleagues," he said and glared down at her. "But that's up to you."

Yowser.

There was no reason for this to have been strung out into several tension-filled and marathon meetings.

Supervisors had several opportunities to fix the problem, starting in 2009. Or they could have stepped in when they got the first Segal report in April 2012, or the second in July 2012.

Instead, for reasons many critics feel are purely political, the supervisors not only sat on those reports, they stalled on going out to bid for the new contract.

Well, you know what happens when you try and keep a lid on a boiling pot.

At some point it's gonna boil over.

Surely GEMCare/Dignity didn't appreciate the result, but others did.

Dr. Donald Cornforth, who pursued this issue for years, was ecstatic. Cornforth has been tightly associated with San Joaquin Hospital over the years so isn't completely unbiased. But he resigned from San Joaquin's board and severed other ties in order to pursue this issue simply as a citizen, he said.

"It was a good day for open government," he concluded after Tuesday's vote.

Opinions expressed in this column are those of Lois Henry, not The Bakersfield Californian. Her column appears Wednesdays and Sundays. Comment at http://www.bakersfield.com, call her at 395-7373 or e-mail lhenry@bakersfield.com

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