System breakdown (continued)

Here, you’d never guess that CNSI technicians have been in Maine on emergency retainer since the system went live last winter, scrambling to fix 265 software bugs. And you might also never know that the federal Centers for Medicare and Medicaid Services (CMS), which is helping to pay for MECMS, breezed into the state, brows furrowed, in late July and found that CNSI techs were making things worse. In a confidential August report to DHHS obtained by the Phoenix, CMS representatives Bob Guenther and Angelo Pardo wrote that the daily changes to MECMS made by CNSI techs weren’t being shared with anyone else. So the computer system which already mystified much of the DHHS department charged with running it was being made more confusing by the hour.

This had gone on for a couple of months.

"Changes were being made almost daily to the system by CNSI programmers without knowledge of project management," wrote Guenther and Pardo, "changes were not being tested prior to implementation, and the system documentation was not being updated to reflect changes that were being made on the fly to the system design."

According to Norton, the state is withholding nearly $5 million of the total $21.6 million MECMS price tag from CNSI until the system is working. He says this is standard practice and not related to the problems the state has had with the program. Norton and deputy commissioner Hall say no plans have been made to sue CNSI for losses incurred by their faulty program, at least not until the company has told the state how to run the damn thing. (Meanwhile, in January 2005, the same month MECMS awoke ailing, CNSI signed a $66.77 million contract to install a similar system in Washington state.)

According to Norton, CNSI had never implemented a healthcare program of the magnitude of MECMS before it was hired by DHHS, after a competitive bidding process, to build it from the ground up.

"People are looking for someone to blame," says Norton. "And what we’re saying is, even if we thought it were a smart idea to look at this as a simple personality or person [at fault], they wouldn’t even be here to satisfy that. People need to look at MaineCare and say, ‘Is this thing going to work?’ "

WHAT’S IT COST?

Let’s assume for a moment the person who approved the launch has been temporarily transported to Mars and, indeed, can’t be tracked down. Even if this broken program is miraculously fixed next week, how much has it already cost us?

The answer depends on the numbers you like.

At the very least, the software company which created the broken program, CNSI, has already been paid about $16.6 million (roughly two-thirds of this came from federal matching funds, says Norton).

Because CNSI proved to be overwhelmed by the scale of MECMS once it was implemented, the state had to pay to bring in outside help. Deloitte Consulting was hired to address organizational problems related to MECMS at a projected final cost of about $4 million, says Norton. XWave, the Canadian tech firm on site to fix what CNSI can’t, is projected to cost about $500,000. These final bills assume the program is fixed in the next several months.

Eight full-time receptionists from the Public Consulting Group in Augusta were also hired by DHHS to handle the increased call-volume from wigging providers, at a cost of $300,000 for the year.

According to Roseanne Pawelek, spokesperson for the Centers for Medicare and Medicaid Services’ Boston office, CMS received a request last week from Maine for federal funds to help offset the extra cost of the consultants. She says CMS is currently evaluating the request and could reimburse the state between 50 percent and 90 percent of these extra costs, although CMS is under no obligation to help Maine beyond the initial price of the program.

But the truly debilitating expense could come care of the MaineCare providers.

A bill sponsored by representative Jeff Kaelin (R-Winterport), LD 1631, would reimburse providers for all the money they have spent adjusting to delays in MaineCare payment. This means the state would foot the bill for accounting and banking fees to balance providers’ now shredded books, among other administrative expenses. Senator Arthur Mayo (D-Bath), as co-chair of the Health and Human Services Committee, will review the bill sometime after the next session begins in January. He says lawmakers feel something should be done to help providers pay for MECMS-related work (co-chair Representative Hannah Pingree (D-North Haven) also supports the bill). If something isn’t done, the general consensus in Augusta is a bunch of providers will ditch MaineCare for good. But Mayo says the problem with LD 1631 is no one has any idea yet how much it might cost.

"We’ve got to have more information," Mayo says. "What are we talking about in terms of numbers?"

Mayo was so hedgy about the secondary costs of MECMS that he wouldn’t even "hazard a guess" as to whether reimbursing providers for extra accounting costs will run into the thousands, the hundreds of thousands, or the millions. He predicts a lot of debate about LD 1631 at the committee level, especially because no one seems sure where the money will come from to pay for the bill if it passes.

According to Smith of the Maine Medical Association, every MaineCare provider in MMA will have to spend weeks to months to balance their books in the wake of estimated payments, incorrect payments, and delayed payments from MECMS. Dyer of the Maine Association for Community Service Providers estimates extra accounting costs for even her smallest member (an owner of two assisted living homes serving eight people in central Maine) will be several thousand dollars. Multiply this by the some 7000 MaineCare providers, with MaineCare patient loads ranging from several people to hundreds, and the price tag for LD 1631 could be staggering.

Mary Mayhew, the Vice President of Government Affairs for the Maine Hospital Association (MHA), a trade organization in Augusta for all 38 of the state’s hospitals, describes the cost of fixing what MECMS got wrong for MHA alone as a hefty chunk of change. In a letter to the Joint Appropriations and Financial Affairs Committee on September 29, Mayhew wrote, "The administrative expense of re-filing and accounting for hundreds of thousands of missing claims will be many millions of dollars."

All of this, and the program still isn’t working properly. Remember those 347,181 claims "in suspension"? As of September 25, DHHS reports that roughly 84 percent of weekly submitted claims are being paid or denied (an improvement of 3.5 percent since August 28 and 31 percent since July 10, though providers still report the payments are often inaccurate). So things do seem to be ironing out, if lately plateauing. The number of suspended claims this late in the game is still almost 10 times that under the old MaineCare processing program — in December 2004, the month before the new system was launched, the old program had only about 37,000 suspended claims, according to estimates from Norton.

Norton, Hall, DHHS commissioner Nicholas, and commissioner of the Department of Administrative and Financial Services Rebecca Wyke say the program is improving. The federal CMS concluded that it showed enough promise to warrant further federal support. But Smith says the situation is still reprehensible.

"How can you spend $22 million and have a system that fundamentally doesn’t work?" he says. "What if this had been [private insurance companies] Aetna or Anthem? Both of their systems were recently converted to new platforms for billing. They warned us there would be some glitches, there were some, but it got transitioned. If this was Anthem and it was eight months, nine months after this thing and people weren’t getting their payments, they’d lose their license. The Bureau of Insurance would be down there auditing this company. They wouldn’t be able to handle the reputation of not being able to pay providers. Why should the government be any different?"