Health

Sunday, Jan 27 2013 05:00 PM

Doctor pay boost may increase access to care

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    By Henry A. Barrios / The Californian

    Bakersfield pediatrician Dr. Hasmukh Amin has a practice that accepts Medi-Cal patients but is at capacity. He says he turns away 25-30 people each day who are seeking a pediatrician who accepts Medi-Cal.

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  2. 2 of 3

    By Henry A. Barrios / The Californian

    Bakersfield pediatrician Dr. Hasmukh Amin has a very large practice. He accepts Medi-Cal patients but is at capacity. He says he turns away 25-30 people each day who are seeking a pediatrician who accepts Medi-Cal. He is examining Marcus and Major Thompson.

    click to expand click to collapse
  3. 3 of 3

    By Henry A. Barrios / The CalifornianBakersfield pediatrician Dr. Hasmukh Amin has a very large practice. He accepts Medi-Cal patients but is at capacity. He says he turns away 25-30 people each day who are seeking a pediatrician who accepts Medi-Cal. He is examining Marcus and Major Thompson.

    Henry A. Barrios / The CalifornianBakersfield pediatrician Dr. Hasmukh Amin has a very large practice. He accepts Medi-Cal patients but is at capacity. He says he turns away 25-30 people each day who are seeking a pediatrician who accepts Medi-Cal. He is examining Marcus and Major Thompson.

    click to expand click to collapse
BY EMILY BAZAR CHCF Center for Health Reporting

Bakersfield doctor Hasmukh Amin is bracing for competition.

Amin is a pediatrician at Riverwalk Pediatric Clinic, a private practice with about 20,000 patients. About half of those patients are covered by Medi-Cal, a publicly funded health program for low-income and disabled residents.

Related Info

This project is the result of a partnership between The Californian and the CHCF Center for Health Reporting. The Center (www.centerforhealthreporting.org) is an independent news organization that reports about health care issues affecting Californians. It is based at the University of Southern California's Annenberg School for Communication & Journalism and funded by the nonprofit California HealthCare Foundation.

This is the second of a two-part series examining health care reform's effect on the doctor supply for Kern County's most vulnerable residents. Will it bring them more access to care?

On Sunday we looked at Kern County's physician supply. Local health care experts say there aren't enough doctors to see the current population of Medi-Cal patients. So, what happens next year, when so-called Obamacare boosts the local ranks of Medi-Cal patients by tens of thousands?

Today we talk to local doctors about a new, health care reform-driven effort to increase the number of physicians who accept Medi-Cal patients. Some say the two-year Medi-Cal payment boost doctors receive will convince more of them to join the program. Others are skeptical.

Unlike Amin, many local doctors won't see Medi-Cal patients, saying the payment rates are too low and don't cover costs.

But starting this month, that could change as some Medi-Cal rates rise temporarily -- and dramatically.

"More and more practices will open up," Amin predicted. "I think I'm going to have more competition."

That competition is being spurred by a two-year increase in Medi-Cal rates funded by the federal government as part of Obamacare. It boosts payments to family physicians, internists and pediatricians for many primary care services in 2013 and 2014.

In essence, the increase brings Medi-Cal rates up to those of Medicare, the federal health insurance program for people 65 and older. Medicare rates are substantially higher.

"It is the best thing that could happen to the pediatric age group," Amin said.

Amin provided an example: Private insurance companies reimburse between $60 and $120 for a typical pediatric office visit for a sore throat or ear infection, he said. Medi-Cal, he said, pays $27 to $37.

The rate increase will catapult the Medi-Cal payment from $27 to $59, he said.

Because California has one of the nation's lowest payment rates, ranking 47th of the 50 states, the increases will be dramatic. On average, fees will jump by 136 percent, according to the Kaiser Commission on Medicaid and the Uninsured.

California is one of six states where average primary care fees will more than double, the commission says.

"We believe (the rate increase) will serve as a very powerful incentive" for doctors to take more Medi-Cal patients, said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal.

But there's already a hiccup in the payment process. Payments to doctors will be delayed until California's rate increase receives federal approval, he said.

Williams doesn't know when the state might get the go-ahead, but said the reimbursement boost will be implemented retroactively to Jan. 1 when it does come.

"We're working as quickly as possible to get this increase approved and get it delivered to physicians," he said. "It is a priority."

Williams said he doesn't think the delay will diminish doctors' willingness to take Medi-Cal patients.

Dr. Madhu Bhogal, medical director of Bakersfield Memorial Hospital's neonatal unit, agrees that the rate increase will help.

Bhogal used to be in private practice and didn't turn anyone away, including Medi-Cal patients. But she was only able to do that, she said, because her husband works and provided a financial cushion.

"I saw everybody, no matter who. That was my model," she said. "But if you are the sole source of income, it's kind of difficult."

In her current position at the hospital, about three-quarters of her patients are on Medi-Cal, she said.

Outside of the hospital, many local doctors tell her they won't take Medi-Cal because the rates don't cover their costs, she said.

"They don't even break even," she said. "Even for immunizations, they may get paid for the cost of the vaccine, but the cost of the person administering the vaccine, the syringe, the alcohol, there's a lot of other things they don't get reimbursed for."

She backs Obamacare's new strategy.

"The only way I see this improving is if the rates for the physicians improve," she said.

At Amin's practice, the rate increase will mean that he and the other doctors will be able to spend more time with each patient, he said, improving the quality of care.

"We're already doing a good job, but we will try to do a better job," he said.

But one local doctor said the rate increase won't convince her to accept Medi-Cal, and other doctors may be wary as well.

Jennifer Abraham worked for the county until a few years ago and saw Medi-Cal patients all the time as an attending physician at Kern Medical Center.

Then, in 2010, the Bakersfield internal medicine doctor went into solo private practice and decided she could no longer see them.

"I could not accept Medi-Cal at my private practice because the costs of running a private practice were greater than the reimbursement," she said. "If I were to accept Medi-Cal, it would essentially cost me to see a patient."

Because her private practice is already full, Abraham said she can't take new Medi-Cal patients anyway.

But even if her practice weren't full, the limited lifespan of the rate increase would worry her, she said.

"If I had room in my practice, which I don't, I still would be reluctant to accept Medi-Cal patients not knowing what's going to happen after two years."

There may be interest in extending the rates beyond 2014, according to the commission, "particularly if the fee increase succeeds in increasing physician participation."

In the meantime, federal regulations require states to collect and report data about the impact of the increased fees.

And in California, some doctors may have their Medi-Cal rates cut while others receive the increase.

In 2011, state lawmakers approved a 10 percent cut to Medi-Cal provider reimbursement rates, but it hasn't gone into effect pending legal challenges.

The latest development came last month, when a three-judge panel of the U.S. Court of Appeals for the 9th Circuit ruled that the cut could move forward.

Opponents vow to continue to fight. But should the reduced rate take effect, it will be applied selectively to different medical providers.

Primary care physicians, pediatricians and others who are eligible for the rate increase under Obamacare won't be subject to the state's rate cut, Williams said. But others who don't qualify for the federal rate increase, including specialists, will be.

"Doctors who are not eligible for the increase will see their payments reduced by 10 percent for all services, except children's services," he said.

-- Californian Staff Writer Rachel Cook contributed to this report

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