Cutting Medicaid Costs, The Problem With Vision, And Scary Thoughts on Schools

Plus: Manager must-reads, the importance of good data, and more management news
by | December 2, 2010
 

Cutting Medicaid costs. Many state legislators are worried sick over how they're going to pay for health-care costs — Medicaid specifically — in coming years. The Palm Beach Post pointed us to one potential experiment in Florida. (Actually, the Kaiser Daily Health Policy Report pointed us to the Palm Beach Post.) Here's what the Post had to say:

"One proposal by Republican lawmakers to help reduce the $20 billion that Florida expects to pay for health care for the poor in the coming year hinges on an age-old battle between doctors and lawyers: whether doctors should be protected from medical malpractice lawsuits.

"While the legislature's investigation into how to cut its Medicaid budget is still in preliminary stages, much of the discussion so far has included talk of limiting lawsuits against doctors to entice more of them into the program.

"Whether this would actually help lower costs or even lure more doctors into the program is unclear.

"Florida Medical Association director of governmental affairs Jeff Scott said Medicaid's low reimbursement rates to doctors 'would probably be the primary reason' many doctors now refuse to treat Medicaid patients."


Thanks again to Blogging Innovation for this lovely little Japanese proverb that applies to a great many government activities: "Vision without action is a daydream. Action with without vision is a nightmare."


Two scary thoughts: 1.) Most school districts don't really know how much they're spending on professional development. 2.) Most school districts don't have any good idea of how much the professional development they do offer genuinely improves the quality of teaching.

At least, those are the messages from a recent article in Education Week by Stephen Sawchuk:

"As a number of researchers have discovered, school districts rarely have a good fix on how much they actually spend on such training -- or on what that spending buys in the way of teacher or student learning.

"Because districts tend to characterize professional development as programming, they typically underestimate other investments in teachers' knowledge and skills — such as how much they spend on salaries during hours teachers attend in-service workshops, according to experts who study district budgeting on professional development."

"What's more, few professional-development activities are linked to outcome measures of whether a teacher has increased his or her capacity to instruct students, they say."


Manager's Reading List. Our thanks to Michael Jacobson, performance management section manager of King County, Wash., for his recommendation of the book Death by Meeting, by management consultant Patrick Lencioni. The book tries to lead readers out of the forest of empty or painful meetings.

Of course we always welcome Manager's Reading List submissions from B&G readers. Be sure to check out our continually updated essential library for managers, and by all means, e-mail us any must-reads on your list.


Good data is key to good decision making in government. We've been trumpeting that horn for years now and were pleased to see a judge implementing that notion, as described in an article in the Recorder, a California publication that covers legal news.

Here's the story, briefly: An executive was convicted a little over a year ago of wire fraud. Apparently, he had sent out a misleading press release to boost sales of a new drug. According to the Recorder, "prosecutors claimed [he] lied in the press release about the results of a clinical trial." That much seemed clear, but the federal district judge, Marilyn Hall Patel, said that prosecutors were claiming a loss figure that might be seriously flawed. The judge "told prosecutors to file some new exhibits and other information using good methodology based on 'real data' on intended and actual loss."


Earmarking has become a popular thing to oppose in Washington, D.C., and it would appear that voters agree. We wonder if this is going to create any problems for the states and cities that often use the same word to mean something entirely different. The earmarking that's become so unpopular (at least in speeches) represents dollars that are required to go to certain districts, for example. But in the states, earmarking is often meant as a way to ensure that tax dollars that are supposed to go to a certain activity actually get there — like lottery proceeds for education expenditures or tobacco-settlement dollars for anti-smoking campaigns. You doubtlessly knew that. But we'll bet others don't understand that there are two very different meanings for the same word.


Not long ago, we published an item in this space about public distrust of government. We speculated that much of the problem emanates from the sheer complexity of government. B&G reader Bob Everett, assessor for Clarendon County, S.C., wrote in with a strong example pertaining to ad volarem taxes: "a number of states now have unbelievably complicated codes relating to valuation methodology, millage calculation, millage allocation, special property classes and much more. I, personally, have about concluded that public mistrust is justified when I have to try to explain all the nuances that have been created in property tax administration. Take a look — it's ugly."


While we're still talking about mistrust of government, we wanted to pass along some thoughts from Patrick B. Edgar, MPA program director at Southern Arkansas University. He wrote us to say he agrees that confusion is a big factor contributing to a widespread lack of faith in civic leaders, but he argued for the consideration of something else: "People are disenchanted with us because we don't ask them before we do things; we ask them after," he wrote.

Edgar continued:

"Janet and Robert Denhardt in their book, New Public Service, explain it well. We have to work harder at citizen engagement so that the public feels they have a genuine role in the decision to provide services. When we have public meetings and begin with a full-fledged plan and then ask them what they think, they are likely to say very little because they can see we've already figured it out. Instead, we need to seek out opportunities to enable them to tell us know what values they see as important and then craft plans around those values, making it clear how we tie the plan to the value.

"As one of my mentors told us repeatedly: 'When asking what the proper role of government is the answer is not "to provide services." The proper answer is to provide for the public forum through which we identify the form, level, and type of services that will be provided.' This, I am convinced, is the key."


We use a variety of search engines to help keep us up-to-date on a number of government-related issues like tax policy, contracting, human resources and so on. When we get up early in the morning, we discover that many of the clips the engines have scooped up come from overseas, where countries — notably England, New Zealand and Australia — seem to be grappling with issues very much like those we face in the United States. Why, we wonder, don't we hear more from states and cities about emulating practices from abroad? We're not saying this never happens. We were impressed, for example, when New York Mayor Michael Bloomberg repeatedly talked about anti-congestion policies in London. We think people could benefit from more of this outside-the-borders thinking.


Innovation. Lots of people use this word as though it was the public-sector equivalent of "open sesame!" Just say "innovation" and the doors to untold riches in effectiveness and efficiency will open. But we fear that people miss a critical point: Most innovations fail. A tried-and-true innovation isn't really an innovation at all.

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