By Michael Abramowitz
July 23, 2014
Officials at East Carolina University’s Brody School of Medicine and their health care delivery partners at Vidant Medical Center are staying connected to their legislative delegation this week as efforts continue to close the gaps in the state’s budget talks.
Through ECU physician services and the school’s relationship with Vidant, Medicaid reimbursement and funding for the medical school remain the central issues that affect the sustainability of health care in the east, university officials and Vidant executives said.
Members of the ECU Board of Trustees are continuing efforts to reinstate the medical school’s setoff debt collection (SODCA) capabilities through state tax refunds, removed by the Legislature in 2013. They also are seeking changes to state Medicaid upper payment limits (UPL) that allow the school to access matching federal Medicaid funds.
Those losses led to a combined $8.5 million revenue shortfall for ECU’s health care services, adding to the loss of $2 million from late Medicaid payments and another $5 million in other losses, according to a report to the trustees from Rick Niswander, vice chancellor for administration and finance.
“The situation continues to change constantly,” ECU communications director Mary Schulken said on Tuesday. “We have no firm information on the status of SODCA or UPLs, but we continue to work hard for a reasonable budget outcome on both of those issues.”
Vidant CEO Dr. David Herman said there seems to be an ideological divide between the position shared by Gov. Pat McCrory and the state House and that of the state Senate. This has prevented a workable solution, he said.
“The House is run from the bottom up, while the Senate is run from the leadership down,” Herman said. “When the House built its budget, it had committee meetings and sub-committee meetings, gathering a lot of input from diverse parties. The Senate never had any sub-committee meetings before it developed its budget. They haven’t sat down with the people responsible for delivering care and providing medical education and tried to come up with implementable solutions. ”
The SODCA and UPL budget provisions do nothing to help balance the state budget or create jobs in North Carolina, Herman said.
“SODCA is money that’s owed by people who have received services at the Brody School, which it, in distinction from more than 100 other state agencies, cannot collect,” Herman said. “The senators say that Brody physicians would be provided an uneven playing field versus other medical providers across the state, but I don’t see Brody medical providers being in competition with any other providers across the state.”
Clarifying the competitive picture among his Senate colleagues has been a difficult task, Sen. Louis Pate, R-Wayne, admitted on Tuesday.
“All of the eastern delegation is solidly behind SODCA and the UPL efforts,” Pate said. “Our numbers are more in line with what the Brody School and Vidant have to have. It’s been worrisome to us ever since the information came out three months ago. I think we’re convincing our brethren across the state that it’s got to be done.”
A sticking point, Pate said, is the difficulty that legislators have had getting accurate fiscal information from the state’s Health and Human Services Department because of problems with its NC TRACKS and NC FAST computer systems.
“We’re finally beginning to get more accurate data, due to their increased diligence, particularly from NC TRACKS,” Pate said. “FAST is … not so fast.”
With the short legislative session quickly drawing to an end, Pate said he believes there is impetus to resolve differences and make what he said are needed changes.
“We’ve been drawing closer to a solution, but, like moths drawn to a flame, we’re trying not to get burned,” Pate said. “We’re getting to a place now, though, where it’s time to get things accomplished. There’s a lot of incentive for us to reach an agreement, and I’m hopeful we’ll be able to get there within the next few days.”