Study: Percentage of physicians not accepting new Medicaid patients rises

News Story:

Doctors Taking Less Medicaid Patients

By KEVIN FREKING
The Associated Press
Thursday, August 17, 2006; 1:38 AM



WASHINGTON -- Many people who rely on government health insurance for the poor have to search harder to find a doctor and increasingly are going to large practices, a study shows.

Officials say Medicaid's reimbursement rate is the biggest reason that it is getting more difficult to locate doctors who take new patients under the program. On average, reimbursements are 69 percent of what Medicare pays and even lower compared with what private insurers pay.

Doctors frequently complain about the administrative hassles. For example, physicians often have to get approval before prescribing medicine or conducting tests.

Overall, the percentage of physicians not accepting new Medicaid patients has risen from about 19.5 in the mid-1990s to about 21 over the past few years. The change was much more pronounced among solo and small group practices.

It is not clear whether the trend has prevented Medicaid participants from getting medical care, but the potential is there if it continues, the study's authors said.

"Many of the large Medicaid providers are located in areas where enrollees tend to live, such as inner cities and medically underserved areas," according to the Center for Studying Health System Change, which conducted the study.

The center compared telephone surveys that it periodically conducts with doctors to reach its findings. It compared the survey from 1996-97 with one from 2004-05. In the earlier survey, 29 percent of solo physicians reported no new Medicaid patients. Nearly a decade later, 35.3 percent of solo physicians reported accepting no new Medicaid patients.

A similar trend was found in small group practices where the percentage of doctors not accepting Medicaid patients grew from 16.2 to 24 percent. Small group practices consist of up to nine doctors.

Dr. J. Edward Hill, immediate past president of the American Medical Association, said government cuts to Medicaid have made it harder for physicians to provide care.

"This unsettling data comes as little surprise given Medicaid's high administrative costs and low payment rates, while the overhead costs associated with practicing medicine continue to increase," Hill said.

He also warned that fewer doctors will want to take on older people as new patients if the federal government reduces reimbursement rates for doctors serving Medicare beneficiaries, as has been proposed for next year.

The Washington-based center describes itself as a nonpartisan policy research organization that focuses on health care issues. It is funded mainly by The Robert Wood Johnson Foundation, a health advocacy organization.

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On the Net:

Center for Studying Health System Change: http://www.hschange.com

© 2006 The Associated Press

Resources on Medicaid Policy Changes -- Kaiser Commission on Medicaid and the Uninsured

Resources on Medicaid Policy Changes in the Federal Budget Reconciliation Bill

The Foundation's Kaiser Commission on Medicaid and the Uninsured has collected resources related to the Medicaid policy changes in the budget reconciliation law, Deficit Reduction Act of 2005.

Information About Evaluation of Medicaid Reform

Evaluation of Medicaid Reform

Contractor: University of Florida, Department of Health Services Research, Management and Policy

Agency Contract Number: MED027

Contract Period: 12/19/05-06/30/10

Summary:

This contract is for the design and implementation of an independent Medicaid Reform Evaluation Study. The goals of the evaluation are specifically intended to align with the goals of Medicaid Reform. As a consequence, the evaluation is expected to adapt to the evolution of Medicaid Reform and the goals thereof as that process moves towards contracts, agreements, and other aspects of program implementation. ..... Projects to be conducted include:

Organizational analyses

Utilization and payment analyses; and

Quality of care, outcomes, and patient satisfaction assessment.

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Governor Bush's Comments on Medicaid Reform 12/10/05

Posted on Sat, Dec. 10, 2005


FLORIDA GOVERNMENT
Medicaid reform benefits Broward patients

BY JEB BUSH
www.myflorida.com

On Thursday, the Florida Legislature passed significant legislation to begin a historic statewide reform of Florida's Medicaid program. This legislation will offer more choices to Florida Medicaid participants and flexibility to providers to respond to the diverse needs of the more than two million Floridians who rely on Medicaid.

The first phase of the reform plan will be implemented in Duval and Broward counties. Thanks to the hard work and vision of the Legislature and the Agency for Health Care Administration, thousands of patients in these counties will soon have the opportunity to receive better healthcare and costs will become more predictable, allowing the state to better manage spending.

We will expand Medicaid reform to the rest of Florida within five years after closely reviewing results and best practices in the pilot counties.

This reform will empower participants to choose coordinated healthcare plans that best meet their needs, while spurring innovation, efficiency and improvements in the quality and access of care.

Florida's model will use time-honored market principles to drive better results. We want to improve health outcomes for the more than two million vulnerable, elderly and disabled Floridians who depend on Medicaid by enhancing their access to quality care and creating incentives for providers and consumers to focus on prevention.

By doing so, we will stabilize the program's costs while maintaining current eligibility and broadening the scope of services. We will empower consumers with unprecedented choice and unleash the innovative and competitive talents of providers.

Participants, with the assistance of counselors, will choose the best plan for them. Or, they can choose to opt out of Medicaid plans and use their state-paid premium to purchase insurance in the private market.

We will also give participants credits for approved health-related expenses such as smoking cessation classes and other health services not covered in their plan. This will encourage participants to engage in healthy lifestyle choices, improving health and lowering acute care costs.

Healthcare providers will be able to compete for participants by offering innovative care, convenient networks and optional services. This will harness the power of the marketplace to drive inefficiency and fraud out of the system.

In a competitive market environment, healthcare providers will search for ways to raise the quality of care and lower costs. And by introducing incentives to reward healthy lifestyle choices and giving consumers more input into their healthcare, we will improve the health of our citizens.

In addition, the inefficiencies caused by lack of choice, lack of focus on preventive care and lack of competition have made Medicaid's growth unsustainable. This year Florida's Medicaid Program will cost a record $15.5 billion -- nearly 25 percent of the state budget. Since 1999, our Medicaid costs have risen 120 percent.

Florida's average annual general revenue growth since 1999 is 5.5 percent. However, that robust rate of growth cannot keep up with Medicaid costs that have risen an average of 13 percent each year during the same period. If left unaddressed, Medicaid could consume nearly 60 percent of the state's budget by 2015, draining valuable resources away from education, public safety and other services.

This growth is not only unsustainable; it creates no corresponding increase in the quality or availability of services for the people who rely on Medicaid for healthcare.

Effective Medicaid reform will happen by giving states like Florida the power and the flexibility to build a Medicaid system for the 21st century. On Thursday in Florida, we took an important step not only to better serve Floridians but also to offer a model for other states to follow and give millions of citizens the healthcare they deserve.

Jeb Bush is governor of Florida.

FLORIDA MEDICAID REFORM - National Conference of State Legislatures

Source: National Conference of State Legislatures
August 25, 2006

The Florida legislature took a major step in May to change the nature of the Medicaid program in the state, with an eye to controlling future program growth and introducing greater benefit flexibility for providers and consumers.


With passage of SB 838, the legislature set the state on the path to a new defined contribution managed care model to be pilot tested in two counties after federal approval of a 1115 demonstration waiver. A “defined contribution” plan means a fixed premium paid to the provider organization per plan member, rather than a “fixed benefit” model under which the provider is reimbursed for the delivery of specific services.


SB 838 calls for the Florida Agency for Health Care Administration (AHCA) to create a capitated (fixed payment) managed care system for all Medicaid recipients in fee-for-service or other managed care systems and in the MediPass (the statewide primary care case management system) program. No Medicaid-eligible populations are to excluded, although the bill calls for AHCA to develop special “service delivery alternatives” to meet the specific needs of certain disability groups. 1


In partnership with the Department of Elderly Affairs, AHCA is also directed by the legislation to create an integrated (acute and long-term care services) fixed-payment delivery system for elderly Medicaid recipients. Medicaid funding for services provided to people age 60 or older will go into the demonstration project in two areas of the state, with voluntary enrollment to be tested in one of the areas. To be excluded from the pilot are persons age 60 and older with developmental disabilities in the community or in institutions, and persons in that age group in AIDS, traumatic brain injury, and spinal cord injury waiver programs.

Continued.....
We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Washington Post Article on Medicaid Reform 6/12/06

Washington Post article on Medicaid Reform

States' Changes Reshape Medicaid
New Restrictions Aim to Save Money

By Amy Goldstein
Washington Post Staff Writer
Monday, June 12, 2006; Page A01

After winning greater freedom from federal Medicaid rules, states are moving aggressively to transform the nation's largest public health insurance program, adding fees, restricting benefits and creating incentives for patients to take responsibility for their health.

The changes are just beginning in several states that are being watched closely by governors nationwide. Those changes are reshaping Medicaid, which covers 55 million poor and disabled Americans, so that the program more closely resembles private insurance, rather than a social welfare system run with a strong, central government hand.

Starting July 1, West Virginia will phase in a redesigned form of Medicaid that requires patients to sign a "member agreement," promising that they will keep doctors' appointments, take prescribed medicine and not overuse hospital emergency rooms. Patients who refuse to sign or to follow the rules will be eligible for less care.

Kentucky is dividing its Medicaid patients into four categories, depending on their health and their age, with different benefits for each group. Most adults will face higher co-payments for medical services and new limits on prescription drugs. But patients who sign up for a "disease management" program eventually will be able to earn credits toward extra "get-healthy benefits," such as eyeglasses or classes to quit smoking.

Florida, meanwhile, will privatize part of its Medicaid system in September, directing patients in Jacksonville and Broward County to pick from 19 health plans, each offering different services. In a departure from how states have reimbursed doctors or health plans, Florida health officials will rate the health of every Medicaid patient in the two communities and pay for only as much care as officials predict they should need.

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We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

www.floridamedicaidreform.org

Our Blog has an easier-to-remember address: www.floridamedicaidreform.org

Please tell others about our new address. www.floridamedicaidreform.org.
Thank you.








We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

Miami-Dade - Dental HMO flawed, study finds

Dental HMO flawed, study finds

Columbia University reports a Medicaid pilot project is not justifying its budget, while the dental providers complain that the fee level is low.

BY JOHN DORSCHNER

jdorschner@MiamiHerald.com

While Atlantic Dental insists it's doing a good job providing care to poor kids in Miami-Dade County, a study just released by Columbia University concludes the Medicaid pilot project has cost taxpayers ``the same amount for less care and less quality.''

The study by Burton L. Edelstein, a professor of health policy, reports that in the first year of the pilot the dental budget for Medicaid in Miami-Dade increased 1 percent (from $14.9 million to $15.1 million) while the average number of annual dental visits per enrolled child dropped by 61 percent.

Meanwhile, one of the largest providers of dental services under the program, the Community Health of South Dade Inc., known as CHI, said it planned to drop out of the program and no longer serve the dental needs of 6,000 Medicaid kids because the plan pays only $4.25 per child per month.

''We can't continue to provide service for that amount,'' said Brodes Hartley Jr., CHI's chief executive.

Lourdes Tome-Rivas, vice president of operations for Atlantic Dental Inc., or ADI, said the company is being unfairly criticized. The measured drop in services is caused by dentists not reporting all the work they do, she said. They have little motivation to report what they do because they get paid in advance, whether they perform the work or not.

Tome-Rivas pointed to a University of Florida survey, released last month, which found that 80 percent of Medicaid recipients interviewed said they had ''no problem'' getting a dentist they were happy with. She said critics charged unfairly that survey could not be trusted, while at the same time accepting the survey of dentists that showed 57 percent were dissatisfied with the program.

''The biggest difficulty is a funding issue,'' said Marcio Cabrera, an ADI director. ``People say they're upset with ADI. But they are really upset with the funding.''

Cabrera contrasted the Medicaid pilot with Healthy Kids, another state-funded program in which parents pay sliding premiums based on annual income. Though the benefits in the two programs are not directly comparable, ADI gets about $10 a month per kid in Health Kids -- twice the rate for Medicaid. ``And we don't get any complaints with Healthy Kids.''

Under the Medicaid project, each dentist is assigned several hundred kids and gets paid $4.25 a month -- $51 a year -- for each. The Florida Dental Association maintains that's not enough, and critics say the only way the dentists can make money on the plan is to limit their treatment of Medicaid kids.

Still, ADI executives say they're not demanding more money from the state in their new two-year contract, which is scheduled to start next month, and Medicaid official Tom Arnold said increased funding is not a possibility because the basic goal of the pilot project basic was to control soaring Medicaid costs.

That cost-containment has hammered CHI, which says it has lost more than $400,000 a year due to the pilot project, which started July 1, 2004. As a federally qualified health center, serving the uninsured and the poor, CHI used to receive $129 a visit each time a Medicaid child was treated by one of its six full-time dentists or several hygienists.

In effect, the $129 reimbursement served as a subsidy for all the uninsured care the clinics provided, and the $4.25 a month per kid doesn't come anywhere near the salaries of the dentists and hygienists. ''We're struggling every day to make ends meet,'' said CEO Hartley, saying he may have to lay off dentists.

Medicaid spokeswoman Krista Moody said federal regulations state the CHI subsidy didn't apply to programs like ADIs. ``It is a business decision made by CHI as to whether or not they can continue their participation.''

If CHI drops out, the 6,000 children will then be assigned to other dentists in the ADI plan who are willing to do the work for the $4.25 a month.

The Columbia study, funded by the Community Voices Miami project at the Collins Center for Public Policy, relied on data reported by dentists to ADI. It said simple teeth cleanings, which had numbered 75,911 under the old fee-for-service plan, dropped by 59 percent to 31,106 under the new dental plan.

Community Voices acknowledged underreporting might account for part of the drop, but ``it is unlikely that the measurable declines in quality are due solely to poor reporting.''

Cabrera said ADI is trying to do a better job getting dentists to report accurately. ``At the end of the day, it is our responsibility.''

For a month, as a test, ADI offered dentists an extra $30 per cleaning if they reported the service, and there was a huge spike in reported cleanings, but the Medicaid contract doesn't allow that kind of payment regularly, and the test was quickly stopped.

ADI has a call center where operators call Medicaid recipients, urging them to go to dentists and even makes appointments for them, but 35 percent or 40 percent don't show up for the appointments, according to Miguel A. Montilla of ADI.

Moody, the Medicaid spokeswoman, said a contract was being drawn up that will extend the ADI pilot another two years but will require more accurate reporting.

Understanding Florida's Medicaid Reform

Article About Medicaid Reform

Source: Florida Tax Watch December 2005

Enhanced Benefit Account Services Program - upcoming trainings

Source: AHCA

You will receive information on the activities that will earn enhanced benefits for you. When you complete one of the activities, credits will be deposited into an account for you. You will be able to access the credits in that account to pay for over the counter health-related supplies that are not already covered by Florida Medicaid, such as vitamins. If you leave Florida Medicaid coverage, you may still use the remaining credits in your enhanced benefit account to pay for health related supplies.

The Agency for Health Care Administration announces all future Enhanced Benefits Advisory Panel meetings.

DATES AND TIMES:

September 5, 2006
9:30 am-12:00pm October 17, 2006
9:30 am-12:00pm October 3, 2006
9:30 am-12:00pm
September 19, 2006
9:30 am-12:00pm October 31, 2006
9:30 am-12:00pm

PLACE:
Agency for Healthcare Administration
2727 Mahan Drive
Building 3
Conference Room C
Tallahassee, FL 32308

Those not able to attend in person may call the conference telephone number (850) 414-1711.

GENERAL SUBJECT MATTER TO BE CONSIDERED: The Enhanced Benefit panel will discuss issues related to the technical aspects of the Enhanced Benefit program, under Medicaid Reform. Anyone needing further information, or special accommodations under the Americans with Disabilities Act of 1990, should write to the address given below or call (850) 488-3560. Special Accommodations requests under the Americans with Disabilities Act should be made at least seven days prior to the Public hearing.

A copy of the agenda may be obtained by writing: Joshua Davis, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #48, Tallahassee, FL 32308.


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