A 73-year-old man who lives in Avery County said he applied for the Pandemic Unemployment Assistance program in May.
AVERY COUNTY, N.C. — A WCNC Charlotte Defenders investigation is learning about an older couple who was forced to ration their medicine while waiting for unemployment benefits.
A 73-year-old man who lives in Avery County said he applied for the Pandemic Unemployment Assistance program in May. He was waiting five months with no answer.
In the meantime, he said he and his wife were cutting spending, including on their prescription medicines.
Richard Warriner said every time he calls to talk to an agent with the North Carolina Department of Employment Security, he’s told his claim is good to go, which is why he’s confused about why he was waiting for several months with no payment.
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“I don’t like living like this,” Warriner said. “You’re just like being a gerbil on a wheel and we’re not going anywhere.”
Warriner, who does medical schedules for a company in Minnesota, said he took a major pay cut in April when he was making $750 per week, which went down to $250 per week. Initially, he applied for regular unemployment benefits.
“As an independent contractor, I was deemed ineligible,” said Warriner.
Then he switched to the Pandemic Unemployment Assistance program in May and waited months for an answer. He said every time he talked to a DES agent, he asked the same question.
“Is there anything wrong with my file you can see?’ And every time everybody said ‘No, it looks great, you should be getting it’,” said Warriner.
In the meantime, Warriner said his refrigerator broke down. He also said he and his wife were holding off on car repairs, and even rationing their prescription medications.
“Instead of taking two pills a day you take one, so you don’t have to refill it as often,” Warriner said.
Warriner said he has friends in other states who applied for unemployment benefits and were already paid. In North Carolina, he doesn’t know what else to do to get his payment.
“They have a place on their website where you can update your documents which I have done, but I’m not sure anyone has looked at them,” said Warriner. “I suspect it’s the push of a button on a computer and it’s resolved.”
There has now been a major update to Warriner’s case within the past month. He said his case was resolved after he contacted the Defenders team and he also reached out to a state representative who agreed to help. Now, Warriner is getting his unemployment payments.
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For decades, health care executives and policy makers have voiced the need for the health care industry to reward value over volume. While there have been promising alternative payment pilots, a vast majority of the US health care system remains financed through fee-for-service payments, meaning that more office visits, hospitalizations, or procedures will generate more revenue and margin. The coronavirus pandemic has challenged this decades-long business model. As elective procedures and office visits declined, health systems across the country lost billions of dollars. Hospitals, integrated health systems, and even independent practices are now facing a financial crisis when patients and families need them most.
Policy experts are increasingly advocating for capitated forms of reimbursement for health systems such as global capitation or budgeting. These are risk-adjusted lump sum payments based on the number of patients a provider organization is serving. In global capitation models, these payments would cover total cost of care. The immediate benefits of capitation during the pandemic are obvious: liquidity-constrained health systems receive cash inflow independent of procedures and office visits performed. There are also long-term benefits to capitation, such as rewarding judicious use of health care resources. However, often unstated are the key challenges and risks that health care organizations must navigate if they plan to execute capitation for their health systems in the long run. We address some of these challenges here.
Consolidated Health Systems Must Find A Balance Between Funding Hospitals And Alternative Sites Of Care
Over the past decade, US hospitals have pursued an aggressive acquisition of physician practices, and the line continues to blur between the two. In 2012, there were 35,700 hospital-owned physician practices, and in 2018, there were 80,000 hospital-owned physician practices, constituting 128 percent growth. The coronavirus pandemic may actually accelerate these acquisitions due to reduced revenues for independent physician practices.
Consolidation changes the calculus of global capitation. If independent physician groups had control over global capitation payments, there is a clear financial incentive for clinicians to scrutinize hospitalizations and emergency department visits and provide greater service levels to patients. For example, CareMore is a physician-payer group (author S.H. Jain formerly led this group) that accepts full responsibility for total cost of care, which has demonstrated 42 percent fewer hospital admissions than the national average. For consolidated health systems that include hospitals and employed physician groups, health care executives face significant pressure on finding appropriate resource allocation to cover fixed and variable costs of inpatient care while also funding alternative sites of care. Striking this balance with a fixed budget is not obvious, and health care executives may need to divest from more expensive hospital-based labor and capital over the long run.
Specialists Need To Be Paid In A Way That Incentivizes Partnership With Primary Care
Despite calls for increases in the primary care workforce, the number of specialists has outstripped that of primary care physicians. In 2005, primary care physicians comprised 44 percent of the physician workforce, and in 2015, they comprised 37 percent of the physician workforce.