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Why the new healthcare payment system is not working

FAIRFIELD, Ohio (Jeff Hirsh) -- Joyce Thomas has been caring for Philip Tucker, a quadriplegic, for 14 years. Like so many other independent home health care providers, Thomas has fallen through the cracks of a new payment system called My Care Ohio, which for many has turned out to be My Fiasco Ohio. Critics are not surprised.

"If this has been a rocket launch, the rocket would not have made it into orbit," said Cathy Levine.

Levine is the director of a consumer health activist organization named UHCAN Ohio. Her group says the state moved too fast in changing the payment system for patients eligible for both Medicaid and Medicare. The state used to pay the health aides directly. But as of June 1st, insurance companies took over

"In Cincinnati, you have two managed care companies taking on maybe 10,000 patients at once. There's no way they could do that and not have collateral human damage," said Levine.

People like Thomas: "Well, I understand it takes time for things to start s new system but this is going on three months. It should have already been over."

Levine says the state should have started with a small test project-- 500 to 1,000 patients-- not the 100,000-plus now enrolled.

On behalf of several activist groups, Levine warned state and federal officials it seems unrealistic that all the components of readiness will be completed and plans will be ready on day one. The consumer groups requested a 3-6 month startup delay.

"We repeatedly asked the state and federal government to start out with a voluntary enrollment program so that they could work out the kinks before bringing in a lot of people at once," said Levine. "And we lost every step of the way. There was a great insistence of the policy makers to do a lot at once."

Then it got worse. Many independent providers used a service called RhinoBill to electronically file their time sheets with the state. According to UHCAN Ohio, Rhino dropped out of the new system, without immediately telling providers, who then had to start over with other billers.

"So right there you're talking about three to four weeks just to get your name into a system. And you're not getting paid," said John Arnold of UHCAN Ohio.

One big problem with the system is that nobody really knows how many people are being impacted negatively. How many people are not being paid, and how many sick people are not getting the services? The problem is the state doesn't know, and if the insurance companies know, they're not letting it out.

"If it turns out  that it's only out of 115,000 people, 3,000 are having terrible problems, is that unacceptable?" said Levine. "2,000 people is unacceptable. 1,000 people is unacceptable."

There is some good news for Thomas. Two days ago, she received $400 from Aetna insurance:

"And i was able to get my medicine and put gas in my car," said Thomas.

But Thomas says she's owed $1,600 more, which grows each day she takes care of Tucker. "They were promised and we hoped they'd get better care than they had and right now we're in damage control mode," said Levine.

"And you just want to scream why me?" said Thomas.

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