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Tuesday, July 15, 2014

SEX, LIES, CMS, HHS AND MEDI-CAL

Number of Medi-Cal Providers Down by 25% in Spring 2014



Recently Paul Krugman a well known op-editorialist for the New York Times said, 

"Obamacare Fails to Fail"

How many Americans know how health reform is going? For that matter, how many people in the news media are following the positive developments?  

Nearly 25% fewer doctors participated in Medi-Cal during spring of this year than in the spring of 2013, HealthyCal reports. Medi-Cal is California's Medicaid program.   
The drop comes amid a significant increase in Medi-Cal beneficiaries.

Background

Since Medi-Cal was expanded under the Affordable Care Act, more than two million individuals have enrolled in the program, bringing total enrollment to 10.6 million.
Meanwhile, about 600,000 Medi-Cal applications still are pending.

Details of Provider Participation

According to the state Department of Health Care Services, 82,605 doctors were enrolled in Medi-Cal in spring of this year, compared with about 109,000 in spring 2013.
Of participating doctors in May 2014:
  • 43,760 were specialists; and
  • 38,845 were primary care providers (Guzik, HealthyCal, 7/14).

Reasons for Decrease

Providers have noted that Medi-Cal reimbursement rates are among the lowest Medicaid payment rates in the country, and that low rates could cause doctors to stop treating Medi-Cal patients because their overhead costs outstrip reimbursements (California Healthline, 6/23).
However, DHCS spokesperson Anthony Cava said the drop in participating physicians is the result of the agency's efforts to remove providers from the program who have not:
  • Complied with the program's updated application requirements; or
  • Billed the program in 12 months or more.
Cava added that the updated application rules "have strengthened the department's ability to deny or terminate providers who do not comply."

Implications for Access to Care

Cava said that the drop in participating physicians "has not resulted in a decrease in access to care."
Further, he said the agency's provider lists do not specify whether physicians are accepting new patients or how many they are accepting. For example, Cava said that while some physicians on the list have treated about 2,000 Medi-Cal patients, others may only treat a couple or none (HealthyCal, 7/14).
Mr Krugman is an authority on economics and a Nobel Prize winner.  No one should question his theories or opinions .  The problem is that he and others have never had responsibility for individual patients, nor that the health system may sign up all these new consumers, and will fail to deliver...
Empty promises, reassurances, and like Sex, Lies and Videotapes leaves only disappointment and justified anger.
Attribution:  NY Times, California Health Care Foundation
Commentary:


3 comments:

  1. James Roache PharmD
    Millions more enrolled in the last year, now 10.7 million and rising. I believe we now have between 1 in every 3 to 4 'residents' of CA are card-carrying Medi-Cal beneficiaries. Couple that with Mr. Cava diverting attention to his new found ability to remove physician providers rather than addressing the absolute decrease in Medi-Cal providers, it is negligent not to be looking at the true implications to patient care nor asking the right questions as cited in the last paragraph. With our Governor blocking the cancellation of the 10% rate reduction for providers despite the unanimous opinion of our legislative Conference Committee and doing so in a year with record excess tax revenues, instead, he flips the decision back to DHCS to adjust rates only if there is a perceived access to care issue. With fewer and fewer providers it would seem his policy is aimed at creating access issues rather than caring for those that need the care the most with the federal dollars the ACA provided.
    July 15, 2014 at 10:57 AM

    ReplyDelete
  2. Richard VanGorder
    The reality of lost providers is that patient access is going to be negatively impacted even more so than it currently is. Patient's are waiting 6 weeks or more to be seen for routine care. Walk-in patients are being turned away and patients with appointments may wait more than 3 hours to be seen by a care provider. More patients are being seen by nurse practitioners and physician assistants: Some practice sites do not have a physician on-site most of the time and this will negatively impact quality of care. All of this can be traced back to the 10% reduction in Medi-Cal reimbursement on top of the fact that Medi-Cal is one of the lowest Medicaid payers in the country.

    ReplyDelete
  3. Juan P Perez
    People enrolled in Medi-Cal are served by managed care network providers. Doctors in a managed care network do not need to enroll directly in the Medi-Cal program. More people in managed care = fewer Medical enrolled doctors.

    ReplyDelete