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SUNDAY, SEPTEMBER 22, 2013 n STATE EDITION

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UPCOMING HEALTH EVENT

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Medical Center

Nearly five years after Wich-ita voters approved a record-setting $370 million schoolbond issue, local architectsand contractors are reapingthe benefits.

Eighteen architecture firmsand 17 construction compa-nies have landed work as partof the school bond issue, rec-ords show. The Eagle recentlyfiled a request under the Kan-sas Open Records Act forinformation about moneypaid to contractors and archi-tecture firms as part of workrelated to the 2008 bondissue.

Of the nearly $228 millionpaid through Sept. 5 for 70projects, about $153 million– more than two-thirds –went to four architecturefirms and five contractors,which designed and builtseveral new schools or multi-

million-dollar additions toexisting buildings.

Among architects, SchaeferJohnson Cox Frey receivedthe largest payout – morethan $4 million in architec-

ture fees and another $3 mil-lion for overseeing the bond.Next were Spangenberg Phil-lips Tice and GLMV Architec-ture, each with nearly $1.7million, and Howard & Hel-

mer Architects, with about$1.5 million.

Among contractors, the LawCo. received the most bondmoney – about $38 million– for building the new North-east Magnet High School andthe new Mueller Elementary.Next were Dondlinger & Sons,with nearly $30 million;Coonrod & Associates, $25.8million; Walz Harman Huff-man, $25.3 million; and Na-tional Contractors, $22.5million.

Some of those firms madesome of the largest contribu-tions to a group that

Jaime Green/The Wichita Eagle

Bond renovations to North High include a new gym, pool, wrestling room, outdoor athletic facilities, auditorium upgrades,other renovations. In 2008, voters approved a $370 million bond issue in the Wichita school district.

35 ARCHITECTURE FIRMS AND CONTRACTORS LAND WORK

School bond benefits local firms

Since the state turned Medicaid over to privateinsurers in January, it’s the hospitals that havebeen in pain.

Executives at Wichita’s two big hospital systemssay they have seen huge spikes in the number ofMedicaid claims denied by the three companiesthat manage care for much of the state’s poor anddisabled populations.

Having to appeal those denials has delayedpayments and increased administrative red tapefor the hospitals – the opposite of what waspromised when Gov. Sam Brownback shifted thesystem from government to largely private con-trol.

“It’s clearly created significant financial pres-sures on us in 2013, and we’re questioning what

KANCARE EXPERIENCING ‘GROWING PAINS’

More denialof Medicaidclaims seenby hospitals BY KELSEY RYAN AND DION LEFLER The Wichita Eagle

A clear divide over the health care law sep-arates the emerging field of potential GOP candi-dates for the 2016 presidential race, previewingthe battles ahead as they try to rebuild the Re-publican party and seize the White House.

U.S. Sen. Ted Cruz says he will fight “withevery breath” to stop President Obama’s signa-ture domestic achievement, even if that meansshutting down parts of the federal government.It’s an approach that former Florida Gov. JebBush calls “quite dicey” politically for Republi-cans.

Allied on one side are Cruz, U.S. Sen. Marco

POTENTIAL CONTENDERS FOR PRESIDENT

Before World War II pilot Marion Un-ruh returned to duty in the South Pacificin the summer of 1943, he said goodbyeone last time to his hometown of PrettyPrairie.

He flew his B-24 heavy bomber lowalong the town’s Main Street and rockedhis wings.

About five months later, on Dec. 30,1943, his plane was shot down near New

Guinea, and he was taken prisoner bythe Japanese. A colonel in the Army AirCorps’ Fifth Bombardment Group, Unruhwas released shortly after the Japanesesurrendered in August 1945.

As the top ranking officer among theprisoners, Unruh was presented a Japa-nese flag and sword – the same swordused to behead American prisoners – bythe prison’s commander.

Unruh’s story and many more wereshared when about 100 people attendedthe Fifth Bomb Group’s four-day reunion

that wrapped up Saturday night in Wich-ita:

A young navigator from Ohio promiseshe will become a priest if he makes itback from the war alive.

An 18-year-old Texan who lost his legfaces the struggles of war’s aftermath.

A gunner returning to Hickam Fieldafter the early morning bombing of PearlHarbor is fired upon by U.S. ships.

Ten of the 130 known living WWII

Courtesy photo

Marion Unruh, anArmy Air Corpspilot from PrettyPrairie, with his“Pretty PrairieSpecial” B-24bomber in 1943on Guadalcanal.He later becamecommander ofthe FifthBombardmentGroup and aprisoner of warafter being shotdown on Dec. 30,1948.

100 PEOPLE ATTEND GATHERING OF FIFTH BOMBARDMENT GROUP

Families hear WWII vets’ stories at reunion

Please see REUNION, Page 12A

BY RICK PLUMLEEThe Wichita Eagle

Fernando Salazar/The Wichita Eagle

Students participate in a balloon launch to celebrate theirnew multi-purpose room, which was paid for with schoolbonds, at Chisholm Trail Elementary in Park City on Friday.

BY SUZANNE PEREZ TOBIASThe Wichita Eagle Health law

divides 2016GOP hopefuls BY THOMAS BEAUMONTAssociated Press

Please see GOP, Page 6A

WHERE THE MONEYWENT

For a breakdown of what eachcompany has been paid, and theprojects they’ve worked on, seePage 14A.

Please see SCHOOLS, Page 14A

Please see CLAIMS, Page 13A

WWW.KANSAS.COM SUNDAY, SEPTEMBER 22, 2013 n THE WICHITA EAGLE 13A

Right at Home

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Wichita, KS 67205

Phone: 316-531-6477

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our financial position willlook like later in 2013 and2014,” said Hugh Tappan,chief executive at WesleyMedical Center in Wichita.

“We take care of a sub-stantial number of the Med-icaid and uninsured in ourcommunity. But we have tohave a flow of revenue we cananticipate and make sureexpenses can be adjustedaccordingly. It creates somesustainability questions.”

Via Christi Health, Wichita’slargest hospital network, isreporting similar problems.

Cindy Samuelson, of theKansas Hospital Association,said similar complaints havebeen coming in from hospitalsstatewide.

“This is not just in one pock-et of the state,” she said.

Officials of the Kansas De-partment of Health and Envi-ronment, who oversee theprivatized Medicaid programcalled KanCare, have consis-tently labeled problems asgrowing pains and saidthey’re working to solve them.

“I understand that providersare frustrated by transitionalissues that remain,” KDHESecretary Robert Moser saidin an e-mail. “KDHE remainsfocused on solutions, and wehave directed the plans totake a more proactive role inengaging providers in theprocess of resolving outstand-ing issues.”

But Matt Leary, Wesley’schief financial officer, said thenumber of denials and thedollars involved have risen asthe year has gone on.

“There was very little activ-ity for the first couple ofmonths, but the past threemonths, we’ve averaged ap-proximately 400-plus thou-sand dollars a month in de-nials,” he said. “So far, year todate, the KanCare providerscollectively have denied $1.6million of our chargesthrough July.”

The dollar figure representsdenied charges for 560 pa-tients, Leary said.

“The same period last year,through traditional Medicaid,we only had 263,” he said.

Via Christi declined to sharespecific numbers, but DavidHadley, its chief financialofficer, said since the begin-ning of the year, the hospitalsystem has seen a nearly 48percent increase in Medicaidclaim payments more than 90days in arrears.

“So despite the ongoingcommunications and effortsbeing made by all parties, itcontinues to be a struggle toget timely and accurate pay-ments for Medicaid accounts,”Hadley said.

‘Monumental change’

KanCare is designed to savemoney for the state by payingthree managed care insurancecompanies a capped rate percovered consumer, ratherthan having state governmentpay the hospitals, doctors andother service providers direct-ly. Medicaid is jointly fundedby federal and state dollars.

About 320,000 Kansans arecovered by KanCare. Theprogram covers low-incomechildren, their parents, preg-nant women, people withdisabilities and some seniorsin conjunction with Medicare.

While hospitals struggleunder the new system, thestate government has beenseeing savings.

Last week, Moser, Brown-

back and Lt. Gov. Jeff Colyer,a doctor, held a Capitol newsconference to announce theyare shifting $37 million fromKanCare savings to providehome- and community-basedservices to 650 people – 400with physical disabilities and250 with mental disabilities– who have been on waitinglists.

Rep. Jim Ward, D-Wichita,is a member of a new legisla-tive committee appointed tooversee the implementationof KanCare. He attended arecent presentation by Tappanat Wesley and said he’ll bringup the hospital’s complaintswhen the committee holds itsfirst meeting Oct. 8.

But he said he’s concernedbecause the committee hasbeen scheduled to meet foronly two days.

“I hope we don’t just havethe dog-and-pony show fromthe (Brownback) adminis-tration,” he said. “I saw thelieutenant governor’s beengoing around saying imple-mentation has gone betterthan expected. I guess not ifyou’re a hospital or doctor orone of the other providers.”

He said he’s not surprisedby the complaints since it’s tomanaged care organizations’advantage to deny and delaypayments.

“Managed care HMOs(health maintenance orga-nizations) in the ’80s and ’90sdid the same thing,” he said.

Rep. David Crum, R-Augus-ta and co-chairman of theoversight committee, alsoattended Tappan’s presenta-tion and said he has beenhearing mixed reviews.

“There are those who areconcerned about denials onclaims and slow payments,but then also a lot of the samefolks who tell me that saythey’re working through theissues and they feel very opti-mistic that those issues aregoing to be resolved,” he said.

He said he plans to ask thecommittee chairwoman, Sen.Mary Pilcher-Cook, R-Shaw-nee, to put the issue on theagenda for the Oct. 8 meet-ing.

“I think what folks have tounderstand is that this is ahuge, monumental change inthe way we’re doing businessand we’re a little over sixmonths into the program,”Crum said. “We obviouslyhave to make sure these is-sues are resolved. I don’tknow that it’s totally surpris-ing that we’re going throughsome of these growing pains.”

KanCare is run by threemanaged care organizations:Amerigroup, UnitedHealth-care and Sunflower StateHealth Plan, a subsidiary ofCentene.

Spokespersons for all threecompanies declined requestsfor interviews and data andreferred questions to thestate.

United sent a statementsaying: “We are committed toworking closely with ourenrollees and providersthrough our advocacy teamsand transparency tools.”

And Amerigroup sent onesaying it values “the care andservices our network of hospi-

tals and professionals provideto our Kansas members andwe will continue make streng-thened provider experienceand relationships a top pri-ority.”

ER visits

Hospital officials hoped thatKanCare would create moremedical homes, where Med-icaid recipients would see aprimary care provider moreoften and seek more preven-tive care, avoiding costly tripsto emergency rooms.

But Tappan said that isn’thappening.

The hospital is seeing in-creased emergency roomvisits for those who qualify forMedicaid, he said – morethan 15,800 total since Kan-Care began.

Tappan and Leary said thatshows that patients aren’taccessing primary care pro-viders for smaller ailmentsand instead are coming to theemergency room.

“So any effort to think thatKanCare was going to helpmove people out of the ERinto medical homes, more

primary care access, for thefirst six months we haven’tseen that on the hospitalside,” Leary said. “And thenon top of that, we continue tosee a significant amount ofuninsured.”

So-called “charity” emer-gency room cases, where thehospital provides free or dis-counted care to low-incomepeople who can’t qualify forMedicaid, have gone from250 last year to 659 so far thisyear, Leary said.

Health care providers sayincreased use of emergencyrooms often leads to highercosts of care for everyone.

The transition has also ledto an increase in adminis-trative overhead, includingfiling of claims, and the med-ical center has added about20 full-time employees be-cause of it, Tappan said.

“We do believe that Kan-Care can work, but todaywe’re not seeing the behavior-al transitions, the medicalhome placement that KanCarepromised,” Tappan said.“What we are seeing is anincrease in Medicaid volumein our ER. We’re seeing an

increase in uninsured and anincrease in charity cases.”

Tappan said he remainshopeful.

“I am choosing to believe atthis point that (the problem)is primarily moving to threemanaged care companies andthe speed at which we tried topush three managed carecompanies,” he said.

“I choose to believe that wewill see this ultimately re-solved, but our short-termexperience is that the hospitalhas been disadvantagedthrough KanCare.”

Incentive to paypromptly

Samuelson, of the KansasHospital Association, hascreated an advisory groupwith its members and officialsof KDHE and insurance com-panies to focus on systemicissues.

“The KDHE has been re-sponsive and the MCOs (in-surance companies) in somecases have not been as re-sponsive” to the complaints,she said. The delay in pay-ments causes cash flow issues

and eats up staff time, shesaid.

One of the issues is that themanaged care companies arenot subject to Kansas’ promptpayment laws, Samuelsonsaid, which generally requirepayment of health insuranceclaims in 30 days.

However, Kari Bruffett,KDHE director of health carefinance, said the companieshave an incentive to promptlypay claims because 3 percentof the state’s payments to thecompanies are withheld un-less they pay out “cleanclaims” within 20 days, ac-cording to the company con-tracts with the state.

Those withholdings are onlypaid to the companies at theend of the year, so it’s tooearly for estimates on whatthe companies will receive,Bruffett said.

“When you consider theextent of the contracts over-all, it’s a considerable in-centive for them to processthose claims promptly,” Bruf-fett said.

Reach Kelsey Ryan at 316-269-6752

or kryan@wichitaeagle.com.

CLAIMSFrom Page 1A

“I choose to believe thatwe will see this ultimatelyresolved, but ourshort-term experience isthat the hospital has beendisadvantaged throughKanCare.”

Hugh Tappan, CEO,Wesley Medical Center

RENO, Nev. – A World WarII soldier’s heartfelt letter tohis daughter has finallyreached her, seven decadesafter it was written.

Peggy Eddington-Smithreceived the letter penned byher father, Pfc. John Edding-ton, as well as his Bronze Starand Purple Heart medals,during an emotional cere-mony Saturday in Dayton,Nev., about 40 miles south-east of Reno.

The father she never metwrote the three-page lettershortly after she was born andshortly before he died in Italyin June 1944. He sent it whilestationed in Texas, just beforehe was sent overseas.

Getting his medals was nice,but the letter meant morebecause it made her feel clos-er to her father, Eddington-Smith said. She knew little

about him since her mothercould rarely bring herself todiscuss the love of her life.

“The letter gave me moreknowledge of who he was,”she said. “He poured out hisheart to me, and a lot of mendon’t put that kind of emotionin writing. I’m just over-whelmed by everything, try-ing to absorb everything.”

Donna Gregory of St. Louisfound the soldier’s letter andother World War II memor-abilia in a box 14 years agowhile helping her then-hus-band clean out his grandpar-ents’ home in Arnold, Mo., aSt. Louis suburb.

Gregory’s voice crackedwith emotion as she read theletter Saturday, bringing tearsto Eddington-Smith and manyin the crowd of about 150.

The soldier devoted the firstpage to his wife, saying hehoped she did not find it “sil-ly” that he was writing a letter

to a child who could not read. Addressing the next two

pages to his “darling” daugh-ter, he wrote that while shemay not see him “for sometime,” he wanted her to knowthat she was always on hismind.

“I love you so much,” theletter says. “Your mother anddaddy … are going to giveyou everything we can. Wewill always give you all thelove we have.”

Eddington urged his daugh-ter to “always treat yourmother right. You have thesweetest mother on theEarth.”

He closed the letter by writ-ing, “I love you with all myheart and soul forever andforever. Your loving daddy.”

Eddington-Smith and Greg-ory are unsure what connec-tion the soldier had to thecouple who owned the housewhere his memorabilia wasfound. Eddington was fromLeadwood, Mo., about 75miles southwest of St. Louis.

Gregory tracked downSmith in June after a searchthat involved libraries and theInternet. Both women criedduring their initial phone

conversation that left thedaughter shocked by theitems’ discovery.

Eddington-Smith knew herfather died in the war. Shewas unaware of the letter and

other contents of the box,including 16 letters from Ed-dington to his mother, hisdraft card and military dogtags, his high school diplomaand newspaper clips.

WWII soldier’s letter finally reaches daughterAssociated Press

Kevin Clifford/Associated Press

Peggy Eddington-Smith, of Dayton, Nev., receives areproduction copy of her father's dog tags during aceremony Saturday.

/Associated Press

This photo provided byDonna Gregory shows thePurple Heart awarded to Pfc.John Farrell Eddington.