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
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