|
|
HOME > ABOUT > PRESS > A REDUCTION IN CARE
Article published - April 20, 2008
Credit: PRESS DEMOCRAT
A REDUCTION IN CARE
Cut in payments to leave those who rely on state coverage with few options, causing ripple effect across the health care landscape
By MARTIN ESPINOZA
A mother sits in the waiting room of the local community clinic, desperate for a doctor to examine her newborn's jaundiced skin. Next to her sits a construction worker with diabetes, and next to him, an aging woman desperate for a more effective pain cocktail to mask her rheumatoid arthritis.
This scene is played out in community health centers across Sonoma County. The patients are here because they have no private health insurance or must rely on state or local medical coverage for the poor, elderly and disabled.
Their ranks, nearly 100,000 uninsured and under-insured Sonoma County residents, continue to grow and make up about one-fifth of county's population of 480,000. And now, the stage is set this summer for a 10 percent reduction in state funds used to pay for the medical bills of more than 50,000 Medi-Cal patients.
The proposed cuts directly affect "safety nets" such as Santa Rosa's Southwest Community Health Center and the remaining private physicians who still care for Medi-Cal patients. The effects could ripple across the local health care landscape, affecting the availibility of doctors and the effectiveness of care, say doctors and health care experts.
"We will see a decline in the health of our community," said Naomi Fuchs, head of the Southwest Community Health Center. "We will see an increase in the cost of health care as more and more people go to emergency rooms and it will be harder to attract doctors to this environment."
A review of the growing pressure on the state's health plan for the poor shows:
Local primary-care physicians have been turning away new Medi-Cal patients for years. Now, some doctors are quietly considering dropping the few remaining Medi-Cal patients they've kept over the years. Doctors say the reason is simple: the state's reimbursement per visit doesn't cover their costs.
As more and more doctors continue to walk away from Medi-Cal, an ever-increasing segment of the county's population will seek out health care at community clinics such as the Southwest Community Health Center, where more than 400 people are currently on a waiting list to see a doctor.
Although Medi-Cal patients can get primary care at community health centers, those who require specialty care have few options.
Low reimbursement rates for Medi-Cal, as well as Medicare, are pushing young family doctors and specialists away.
"What's going to happen to the poor in Sonoma County? Where are they going to get care?" asked Lymen "Bo" Greaves, president of Primary Care Associates of Santa Rosa.
Few doctors take Medi-Cal
Like many other private doctors in the area, Greaves' practice stopped taking new Medi-Cal patients years ago. Only the group's pediatric office still cares for newborns covered by Medi-Cal.
Last year, Primary Care Associates billed Medi-Cal for 4,369 visits with a doctor or nurse practitioner, roughly about 1,500 patients.
The 10 percent cut in Medi-Cal will force him to evaluate whether the practice can continue to afford caring for these patients.
"What impact will this have as we both lose primary care physicians and the few we have left stop seeing Medi-Cal patients?" Greaves said.
Two years ago, the Sonoma County Medical Association conducted a survey among the county's physicians and found that Medi-Cal patients make up an average of 10 percent of a doctor's patient load.
Of the 449 physicians who responded to the survey, 56 percent said they were planning to further limit or eliminate Medi-Cal. And that was two years ago.
Local doctors and health care providers all agree that the cuts will most affect patients unable to access timely health care, particularly from a medical specialist.
For almost a year, Petaluma resident Niki Shmatovich has endured severe pain from her rheumatoid arthritis. She has been unable to find a specialist who will accept her insurance, which was Medi-Cal last year and the county's medical insurance for low-income individuals this year.
"All I want to do is get back to life," Shmatovich said. "I can't even get a hold of a doctor that will do the appropriate blood work and testing to determine what medications are correct."
Shmatovich said her doctor, Petaluma Health Center medical director Kelly Pfeifer, is trying to find a rheumatoid arthritis specialist in San Francisco that will take her case.
Pfeifer warned that the planned 10 percent cut could cause some local specialists to drop what few Medi-Cal patients they still see.
"Some specialists who accept the occasional Medi-Cal patient are at the edge of tolerance," Pfeifer said, adding that she knows of one specialist who "has saved a 12-cent check from Medi-Cal as a memento."
Things may get worse
Although local health centers get a better Medi-Cal reimbursement rate than private doctors or hospitals, the planned cuts will make it more difficult for them to absorb the growing number of uninsured patients, directors said.
Southwest Community Health Center's two campuses in southwest and northeast Santa Rosa have more than 600 new patients a month, a trend that is becoming common at local community clinics and is forcing delays up to eight weeks to see a doctor.
"Medi-Cal patients are being discharged from private practices and we're out of room," she said.
Sonoma County Health Services director Rita Scardaci said long waiting periods for new patients have now become commonplace at private medical practices because of a severe shortage of medical providers and specialists in the county.
She said that without a significant national and state overhaul of health care, things will get worse, especially during an economic slump.
"The uninsured and under-insured will face significant barriers accessing health care along with everyone else," said Scardaci.
Budgetary crisis
Medi-Cal, California's version of the federal Medicaid program, covers 6.6 million people. At $13.5 billion, Medi--Cal is the state's second-largest expenditure next to education in the current $102 billon fiscal year budget.
The 10 percent cut, expected to save the state $500 million, will affect all "fee-for-service" providers, including physicians, medical transportation, pharmacy, home-health, dental, certain long-term care facilities and hospitals that do not contract with Medi-Cal to provide services.
The reduction comes more than a year after Gov. Arnold Schwarzenegger proposed a significant increase in Medi-Cal rates as part of his failed universal health care program. At the time, the governor's office cited independent research that estimated California health insurance premiums had risen 17 percent to cover the cost of the state's uninsured and Medi-Cal underpayments.
"It would have laid the ground work for a physician rate increase that would have begun in 2010," said Norman Williams, a spokesman for the state Department of Health Care Services.
"The governor remains committed to working to solve the problems of the California health care crisis," he said. "But we also have a budget crisis. Medi-Cal, as the second-largest state program, has to be part of the solution."
Schwarzenegger has said he would neither raise taxes nor tinker with eligibility requirements so that fewer California residents would qualify.
The trade-off has been that California Medicaid rates rank 45th among the 50 states, said Chris Perrone, a senior program officer with California Health Care Foundation, an Oakland-based non-profit research group.
Local medical providers say those who are able to get Medi-Cal face fewer and fewer health care options, particularly when it comes to specialty medical care.
"The rates are now getting to a point where they are so low, an increasing number of providers are dropping out of the program altogether," Perrone said.
Patient-load imbalance
Eight years ago, half of all the state's doctors were refusing to accept Medi-Cal as a form of payment, he said. Those who did participate in Medi-Cal were limiting their burden, creating an imbalance where 20 percent of all doctors were providing 80 percent of all Medi-Cal care.
According to the SCMA Survey, Medi--Cal patients comprised 25 percent or less of the patient load for 71 percent of the doctors who accepted Medi-Cal. Only 11 percent of local doctors who accepted Medi-Cal had Medi-Cal patient loads of 50 percent or more.
The SCMA survey found that while the county's population grew by 15 percent between 1995 and 2005, the number of physicians increased by only 11 percent. Meanwhile, the number of physicians working for Kaiser Permanente increased 55 percent, from 164 "full-time equivalents" to 254 FTEs.
'What's going to happen?'
The findings of the survey describe a bleak future for health care in Sonoma County, with almost half of all doctors considering retiring within five years or moving out of the county because of low government reimbursement coupled with the area's high cost of living.
Santa Rosa resident Jennifer Grove, who's been a patient of Dr. Greaves since the early 1980s, said she doesn't know what she would do if he decided to drop her and his other remaining Medi-Cal patients.
Grove, 60, has bronchitis and asthma from years of smoking. In 1998, she said she underwent two open-heart surgeries that required taking veins from one of her legs.
She said Greaves was instrumental in helping her walk again.
"I'm lucky because I have a doctor that cares about me, that cares about his patients," Grove said. "If Medi-Cal doesn't want to pay these doctors and they have to give up half their patients, what's going to happen to these patients?"
|
