System breakdown (continued)

WHO’S AT FAULT?

On September 29, at the meeting of the Joint Commission on Appropriations and Financial Affairs and in the midst of debate about the merits of Mary Mayhew’s claims that members of the Maine Hospital Association are owed hundreds of millions of dollars because of MECMS delays, DHHS Commissioner Nicholas accepted the blame for the project.

"We take total responsibility for the system and challenges it’s made for our providers," Nicholas said. Surrounding him were commissioner Wyke, Chief Information Officer Richard Thompson, and deputy commissioner Hall.

Earlier in the same meeting, Wyke admitted that MECMS was launched prematurely.

"Our biggest problem," she said to the commission, "is the system went live in January and it really is only ready go live now, so we have months and months of backlog."

Representative Darlene Curley (R-Scarborough), who is also a registered nurse and a health-care consultant, joined fellow commission member Senator Richard Nass (R-Acton) in expressing serious concerns about the way MECMS has been handled.

"I think it’s driving up healthcare costs," she said. "Offices are keeping two sets of books. I think there’s going to be an impact on cost and access and I know there are some rural providers who have been permanently put off."

But outside of the meeting, DHHS spokesperson Norton and Hall are still in heavy damage control mode. Neither is willing to place blame on any one person.

Norton says it’s a case of a time-pressured office, which went ahead with a complicated computer program it didn’t have the capacity to understand. He says many who were part of the four-year process which resulted in MECMS don’t even work at DHHS any more.

"I’m not going to get into rattling off names, but there are a number of people who have been involved in management [of MECMS] across the office," he says. "But it’s not about that. People don’t believe that a person or a series of people caused this. It built up over a long, long time. Demands to move forward in this business are pretty dramatic and there’s a lot of pressure to say, ‘Yeah, we can do it.’ "

Certainly, there was intense pressure from the federal government to replace MaineCare’s rustic, circa-1978 Legacy computer system with one which conforms to the national Health Insurance Portability and Accountability Act of 1996 (otherwise known as HIPAA). After all, Maine is the only state in the country which isn’t HIPAA compliant. But there were plenty of other states to look to when DHHS was evaluating what lay ahead with system change. According to the Bangor Daily News, Georgia, which transitioned a similar system in recent years, took about two years to stabilize its program. No one in DHHS seems to have considered that MECMS might not work perfectly right out of the gate.

"Maybe the right question is," says Norton, "if we have no success in terms of both turning around the system and the [overall MaineCare] operation, if people want to look back in a couple of years and say, ‘The computer system still doesn’t work and the management process isn’t any better,’ then I think that it would be appropriate to look at all this and say, ‘Okay, off with their heads.’ "

Meanwhile, Sandi Campbell of Freeport has made an appointment to take her children to the Jesse Albert Dental Center, 20 minutes away in Bath. Jesse Albert is the only public dental clinic in the state to accept new patients. Campbell is reluctant to go, she suspects her 11-year-old won’t be keen to try out a new dentist, but she doesn’t have much choice since her former dentist no longer takes MaineCare because of MECMS. In August, she wrote a letter to Governor Baldacci telling him she lost her dentist because his office wasn’t paid the full amount due. She received what she considers a stock reply, promising that the governor’s office will expedite payment to her dentist if he contacts the state.

For her, the blame goes to the top. She compares the MECMS mess to the New Orleans hurricane response disaster. There were a lot of people who dropped the ball along the way, she believes, but in the end, the fault lies with the man in charge.

"I’m a firm believer, when the government says they’re going to show up and they don’t show up, it’s the leader’s fault," she says. "The governor is responsible for this."

Lynn Kippax, spokesperson for the governor, would not respond to Campbell’s allegations other than to say that the governor is addressing problems within the Office of MaineCare Services which have existed for "decades."

Senator Peter Mills, Republican gubernatorial candidate in 2006, says the societal costs for the MECMS mess are "staggering" and he plans to address it on the floor of the senate this winter. In January, Mills will introduce a bill designed to require that state agencies in transition to the high tech world be better prepared before they blast off.

"My suggestion is that there be a policy that there be a consultant hired in advance," says Mills. "Someone who is not involved in the transaction, who is completely independent, to serve as an advisor that adequate provisions have been made for the transition."

The next monthly Appropriations Committee update on the progress and cost of MECMS will be held on October 20. The meeting begins at 9:30 am in room 228 at the State House in Augusta; it is open to the public. Those interested in the latest scoop on MECMS can sleep in, it’s often placed at the end of the agenda to allow room for discussion.

In the meantime, Smith of the Maine Medical Association continues to spend portions of his week helping member providers work with MECMS. And he doesn’t think the state’s promise to have the program fixed by January 1 holds any water.

"Given that most of the deadlines they have had have slipped a little away, I have no basis to think they’ll keep the January deadline," he says. "Anybody who thinks this is going to be the model of customer service at the end of this year, they’re not going to the same meetings I am."

Sara Donnelly can be reached at sdonnelly@phx.com