Physicians Take Another Medicaid Hit on Louisiana Medical News

Physicians Take Another Medicaid Hit

By: TED GRIGGS

Dr. Patrick Breaux

Forcing doctors to return $17 million in Medicaid overpayments will force physicians to decide whether to continue treating Medicaid patients, according to the Louisiana State Medical Society.

The state Department of Health and Hospitals put off implementing three Medicaid reimbursement reductions called for in state budget cuts over the last 18 months, Medical Society president Dr. Patrick Breaux said in a letter to DHH.

Thousands of Louisiana doctors now face Medicaid reimbursements 15 percent to 45 percent lower than they were in 2008, Breaux says. On top of that, the doctors are now "saddled with a debt" to repay the Medicaid program.

And those debts must be repaid quickly.

Doctors will have the option of paying the entire amount or spreading it out over six to eight months through reduced Medicaid reimbursements, according to DHH.

Department officials have said it took months to change the thousands of codes for provider payments in the state's computerized Medicaid payment system. Physicians received higher reimbursements while the new reimbursements were entered. DHH officials say they have no choice, the department has to get back the $17 million by June 30 because those cuts are part of the formula for balancing the state budget.

The state-ordered Medicaid repayments come as more physicians are considering whether they can afford to treat patients in the government health insurance program for the poor, elderly and disabled.

A Louisiana State Medical Society survey – completed before the repayments were ordered – found that nearly 72 percent of doctors who responded either limit or no longer accept new Medicaid patients.

Some 40.3 percent of respondents say they no longer see any Medicaid patients, and 31.4 percent are considering that option.

Meanwhile, 94.9 percent of survey respondents said it was either "difficult" or "almost impossible" to refer Medicaid patients to specialists. The percentage was up from 86.7 percent in the 2009 survey.

The Medical Society e-mailed the survey to its 3,678 members, roughly half the state's doctors. The society got 386 responses, or roughly 11 percent of the total.

The whittling away of reimbursements and doctors' growing reluctance to treat Medicaid patients is headed for a collision with a mushrooming Medicaid membership. Over the next few years, Louisiana's Medicaid enrollment is expected to grow from around 1.1 million people, or 25 percent of the state's population, to 1.5 million people, or 37 percent of the population.

"There's going to be a big-time problem with access," said Dr. Paul Perkowski, a Baton Rouge vascular surgeon. "And the problem isn't just going to be with the number of physicians – obviously, there's a shortage of physicians – but it's clearly related to reimbursement."

If a doctor can't pay the bills by seeing Medicaid patients, he or she is not going to see Medicaid patients, Perkowski said. The only thing the doctors will be able to do is send those patients to the state's charity system, which is already overwhelmed.

The charity system is already seeing uncompensated care patients and the poor, Perkowski said. Adding more Medicaid patients and more Medicare patients means the system will be even more overtaxed than it is now.

So even if the federal legislation gets people insurance, they may not be able to find a primary care doctor who takes Medicaid or the private insurance they obtain through an insurance exchange, Perkowski said. Those patients are going to go to emergency rooms, after-hours clinics or acute care clinics, wherever they can to get care.

Perkowski said roughly 15 percent of his practice consists of Medicaid patients.

As long as he can pay his rent and his nurses, he will continue to see Medicaid patients, he said, because he can make up the difference with the privately insured.

But pediatricians and family practitioners, depending on where their offices are, may have practices where 80 percent or 90 percent of their patients are covered by Medicaid, Perkowski said. And that leaves only a very small margin of profitability.

Those doctors must weigh the costs for rent, staff, utilities, supplies and insurance against the percentage of Medicaid patients and the reimbursements, Perkowski said. Every day, every week, every month, those doctors are calculating what happens if the Medicaid reimbursements drop; whether another 5 percent cut means the doctors will have to stop seeing new Medicaid patients or Medicaid patients period.

"I'm sure that equation is in the back of their mind all the time," Perkowski said.

Perkowsi said he and other physicians all over the state are struggling with whether they will have to make changes in their practices.

"We don't abandon patients like that," Perkowski said.

It's one thing to answer a question on a survey, he said. It's an entirely different thing when there's a patient sitting in your office.