Medi-Cal cut could hurt patient care, East Bay doctors say

By Sandy Kleffman

Nearly two-thirds of East Bay doctors who treat Medi-Cal patients say they will scale back or stop seeing such patients entirely when a 10 percent cut in reimbursement rates takes effect July 1.

That will make it even tougher for low-income and disabled residents to find a physician willing to treat them, and further erode the health care safety net in the East Bay, patient advocates say.

The Alameda-Contra Costa Medical Association recently surveyed 1,000 doctors in private practice to see how the cuts would affect them.

The results were “rather astonishing to us,” said Dr. Juan Ordonez, association president.

Of the 193 doctors who responded, 45 percent do not currently see Medi-Cal patients.

Among those who do, 33 percent said they would reduce their hours with such patients and 29 percent said they would stop seeing them entirely.

The outlook was even bleaker for patients in need of a new doctor. Fifty-six percent of physicians said they would stop accepting new Medi-Cal patients.

Reimbursement rates are already so low that many doctors believe they cannot keep their practices afloat if they absorb a 10 percent Medi-Cal cut, Ordonez said.

“We know that access to care is going to decrease very significantly,” he said. “This is terrible because the patients are not going to be less sick. The care will be delayed and the patients will go where they can be seen — and Advertisementthat’s an emergency room.”

Medi-Cal is California’s version of the federal Medicaid program. It provides health care to 6.6 million low-income and disabled residents.

Gov. Arnold Schwarzenegger and state lawmakers approved the cut earlier this year to help offset a state budget deficit now estimated at $17.2 billion. The cut will save about $614 million annually.

“The fiscal gap requires these difficult and painful choices,” said Tony Cava, a spokesman for the California Department of Health Care Services. “We’re hoping the providers will stay with us during these difficult times.”

Because Medi-Cal is the second-largest state-funded program, it must play a role in budget solutions, Cava said.

The reduction in reimbursement rates is just one of the Medi-Cal cutbacks contemplated in Sacramento. Other proposals in the budget released last week by the governor include:

Eliminating dental benefits for adult Medi-Cal patients.

Eliminating audiology, optometry, podiatry, speech therapy, psychology, chiropractic care and other nonmandatory benefits.

Reducing the allowable income for enrollment of two-parent households. A parent in a family of three earning $11,000, for example, would no longer be eligible.

But unlike these proposed cuts, the reduction in reimbursement rates has received final approval. It will go into effect July 1, unless a judge intervenes.

Earlier this month, a coalition of groups, including the California Medical Association, California Hospital Association and California Dental Association, sued to block the cut. That case is pending.

Dr. Robert Nicholson, an Oakland pediatrician, estimates that two-thirds of his patients are on Medi-Cal. He will continue seeing them, but said he will have to stop accepting new fee-for-service Medi-Cal patients.

He receives $26 from Medi-Cal for a typical visit with a sick child. The reimbursement from a private insurance company would be $70 to $80. A portion of that $26 must help cover his office rent, insurance, employee salaries and supplies.

“When I walk into this room to take care of a patient, I probably walk out with $5 in my pocket,” Nicholson said. ” … There comes a point where we’re actually contributing to see the patients.”

If the cuts go through, he predicted he will have more difficulty finding specialists willing to see his patients. He said he also may have to consider reducing the hours of his employees.

Despite the difficulties, he does not want to pull the rug out from under his existing Medi-Cal patients.

“You get close to them,” he said. “Many of these patients I’ve seen for two or three generations.”

Dr. Gretchen Graves, a Pittsburg pediatrician, faces similar dilemmas. She estimates that 60 percent to 70 percent of her patients are on Medi-Cal.

“We’re going to continue to see the patients that we have established, but we probably won’t be able to accommodate new patients,” she said.

Graves was so disturbed when she first heard about the 10 percent cut that she fired off an e-mail to Gov. Schwarzenegger telling him it “would be devastating to children in California.”

Medi-Cal pays her about $40 for a comprehensive exam that she would typically receive $140 for from private insurance companies, she said.

“You can only do one or two of these (Medi-Cal) patients a day and really carry it off,” she said.

A 15-minute visit may turn into an hour, yet she still receives the same amount.

“Often, it took them so long to get an appointment, they just unload everything,” she said.

Both Nicholson and Graves are members of the Alameda Alliance for Health, a Medi-Cal managed care plan that serves more than 75,000 Alameda County residents. The Alliance’s $135 million Medi-Cal budget will be cut by $6.7 million to $9.4 million if the cut goes through, Chief Executive Officer Ingrid Lamirault said.

Some of that loss will need to be passed along to the physicians, she said, but she noted that they now receive just $22.90 for a routine office visit, $12 for a preventive care visit and $1.77 for an allergy skin test.

“We’re just trying to hold the network together,” she said. “We don’t want the providers to panic. … But the cost of medical care keeps going up and rates are either staying flat or decreasing.”

Comprehensive health care reform is needed to resolve the problem, Lamirault said.

State health department spokesman Cava noted that the governor proposed increasing Medi-Cal reimbursement rates in his unsuccessful reform proposal last year.

“The governor hasn’t given up — and neither have we — as far as looking to health care reform to increase the reimbursement rates,” Cava said.

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