Patients Access to Care Threatened by Budget Cuts
Patients Access to Care Threatened by Budget Cuts | Louisiana Physicians,Louisiana medicaid,Louisiana doctors,Louisiana health care



State budget cuts proposed for the 2009-2010 fiscal year slashes Medicaid physicians’ payments by more than nine percent, approximately $42 million, and will leave Louisiana’s most vulnerable citizens with fewer options for health care. In addition, case management fees paid to primary care physicians for coordinating their patient’s care and treatment, a program initiated to bring about cost savings in the Medicaid program, will be reduced by approximately $2 million. The progress made in recent years toward increased physician participation in the Medicaid program will unravel, unless the Louisiana Legislature restores the cuts.

"These proposed cuts force physicians to make significant changes in their practices," according to Dave Tarver, Executive Vice President of the LSMS. Tarver pointed out that in 2007 Medicaid payments were increased to an average of 90% of Medicare rates and, since that time, physicians providing services to Medicaid patients has increased over 11%. "In one stroke of the pen, these cuts will roll back that progress," Tarver observed. Citing the most recent LSMS member survey, he said that even with this progress, 87% of respondents found it "difficult" or "almost impossible" to refer their patients to physicians for specialty care.

In past years, slight increases in reimbursement have brought some physicians back into the program, only to have increased operating costs push the costs of providing care well above the payment level. For this reason, physicians were forced to stop seeing Medicaid patients. Tarver cautioned, "Given the drastic nature of these cuts, many physicians will choose to get off the roller coaster and leave the program with no intention of returning."

Louisiana already faces a shortage of physicians, particularly in rural areas with high densities of Medicaid patients. Louisiana’s ratio of physicians per 1,000 of population is below the national average. According to the survey of LSMS member physicians conducted in March 2009, over 65% of respondents indicated it is difficult to recruit new physicians to join their practices. The primary reason given for this difficulty is low reimbursement in Louisiana, even before the drastic cuts in Medicaid reimbursement were proposed. With Louisiana’s Medicaid enrollment at approximately 30% of the population, payment cuts do not encourage physicians to consider relocating to Louisiana. In addition, 42% of Louisiana’s practicing physicians are over 50, an age at which surveys have shown many physicians are now considering reducing their patient care activities.

Under federal rules, physicians cannot receive reimbursement for the uncompensated care they provide to uninsured patients. The recent LSMS survey found that uncompensated care is taking its toll on physician practices. One in four respondents estimated that they provided more than $45,000 in uncompensated care annually. As a result of decreasing reimbursements, 82% of survey participants described the overall revenue of their practices’ as "flat" or "decreasing". Unfortunately, 40% of survey participants already have reduced time spent per patient encounter. Given further payment reductions, physicians indicated they would reduce or eliminate uncompensated care and/or stop accepting new Medicaid and Medicare patients.

"Even before Hurricanes Katrina and Rita, access to care was an issue in Louisiana," explained Dr. Roger D. Smith, President of the LSMS. "These cuts will exacerbate an existing problem. Patients will have increased difficulty in finding or keeping a physician and the state will become even more dependent on the already overburdened safety net system."

About the LSMS Member Survey

A total of 5,239 surveys were mailed to LSMS members. Members were asked to respond via online survey, return mail or fax by March 20, 2009. The survey had a 12% overall response rate. The LSMS is a voluntary association of physicians providing leadership for the advancement of the health of the people of Louisiana and serving as the premier advocate for patients and physicians. For more information about the LSMS, please contact Sadie D. Wilks at or by phone at (225) 763-8500.


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