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Saturday, Jan 26 2013 05:00 PM

Headcount of Medi-Cal-participating doctors hard to come by

BY EMILY BAZAR, CHCF Center for Health Reporting

State health officials say there are 2,023 doctors who see Medi-Cal patients in Kern County.

Here's what Sandi Palumbo, executive director of the Kern County Medical Society, says:

"Whaaaattt!? I didn't even know there were that many licensed physicians in Kern County," she said.

There aren't.

The state Medical and Osteopathic Medical Boards, in charge of licensing doctors who practice in California, show about 1,200 physicians in Kern County, more than 800 fewer than the state's statistic.

Even factoring in doctors who are licensed in other counties and practice in Kern, Palumbo doubts there are that many who take Medi-Cal in the county.

"I question that," she said.

Medi-Cal, the state's version of the federal Medicaid program, is publicly funded health coverage for low-income and disabled residents. But there's little agreement on how many doctors actively accept Medi-Cal in California and whether there are enough of them to provide adequate care to its more than 7 million recipients.

Answering that question is becoming more urgent as the as the state prepares to expand Medi-Cal significantly starting next year, part of President Obama's signature health care law.

As it is, some local health officials and doctors say, there aren't enough doctors to see the current population of Medi-Cal recipients.

"The physician shortage in the valley is a huge challenge. It's not only primary care. It's specialists as well," said Jacey Cooper, executive director of managed care at Kern Medical Center. "We will need to recruit more physicians to the valley to handle the increase in Medi-Cal recipients to provide the care that's necessary."

State officials say that access to Medi-Cal services is adequate and that they are constantly monitoring to ensure that recipients can get care.

Linette Scott, the chief medical information officer for the state Department of Health Care Services, which administers Medi-Cal, offered one possible explanation for the discrepancy in the Kern Medi-Cal doctor numbers: Some doctors who are licensed in other counties also practice in Kern.

The county where a physician gets his or her medical license "doesn't have to have any association with where you practice," she said.

Scott and other state officials also say that the number of doctors on its own does not define access.

"Access is much more complex than the number of providers available," she said, especially as the state moves more Medi-Cal recipients into managed care and models of treatment that rely on teams of health professionals to care for patients, not just individual doctors. These teams include nurse practitioners, physician assistants and other types of providers.

But health care experts say knowing how many doctors actively see Medi-Cal patients is critical on many levels, and is necessary to make important policy decisions, including how much money the state dedicates to the program.

"It would be really helpful for policymakers to have an agreed upon set of facts," said Andrew Bindman, director of the University of California-based California Medicaid Research Institute.

But few can agree.

The Department of Health Care Services says there are 104,239 doctors statewide who are enrolled as providers in the program.

"The provider master file reflects the individuals that have enrolled and have the capability to bill Medi-Cal," Scott said.

Lisa Folberg, vice president of medical and regulatory policy for the California Medical Association, which represents more than 35,000 California doctors, says the state's number is "ridiculously overinflated."

"I can tell you that's impossible," she said. "I can tell you 100 percent definitively."

She points to the number of doctors licensed by the state with addresses in the state: About 107,000.

Folberg said there's no way that almost every doctor in the state accepts Medi-Cal. "Every study across the nation shows that not all physicians participate in Medicaid," she said.

She believes that the state may be double counting some doctors or doesn't remove those from the list who no longer accept Medi-Cal or who have retired or moved away.

State officials say they're making changes to the doctor enrollment process. Up to now, there has been no expiration date on a doctor's enrollment in Medi-Cal, Scott said.

But starting this month, the department will confirm doctors' enrollment in the program every five years, another requirement of Obamacare, said spokesman Anthony Cava. If the department cannot confirm a doctor's status or there are discrepancies in data, the doctor will have to re-enroll in the program, he said.

Under state law, the department already is required to deactivate doctors who hadn't filed a Medi-Cal claim in 12 months. But, Cava said, they've fallen behind because the process takes so much staff time. He said the department plans to "fully comply with requirements" this year.

-- Californian Staff Writer Rachel Cook contributed to this report

 

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