February 13, 2008
Proposed 10% Medi-Cal Cuts Will Cut Patients’ Ability to Find Medical Care, Say Family Physicians Statewide
Warning that Governor Arnold Schwarzenegger's proposed 10% reduction in Medi-Cal payments will likely result in many physicians treating fewer Medi-Cal patients, family medicine physicians are opposing the cut. "This cut would be devastating to patient care," said Carla Kakutani, MD, president of the 7,000-member California Academy of Family Physicians (CAFP).
Kakutani is joined today by physicians from Los Angeles, San Diego, Bakersfield, San Francisco, Santa Rosa, San Jose, Modesto, Monterey County and other areas, all protesting the cuts because of their potential impact on patients.
"A cut to Medi-Cal would inevitably lead to fewer private practices being able to afford to care for these patients, leading more and more to end up in the public health system," said San Francisco family physician Michael Potter, MD, who practices at San Francisco General Hospital and is an associate professor at the University of California-San Francisco. "An influx of Medi-Cal patients into the public health system could provide an important challenge to this city's commitment to provide universal healthcare to its residents."
"Less state funding for healthcare will mean less access to prenatal care, fewer mental health services, fewer immunizations, less care for chronic illnesses such as asthma and diabetes, increased visits to overcrowded emergency rooms for medical conditions that could have been treated better, quicker, and cheaper in a doctor's office, more unnecessary hospitalizations, and a sicker population," Potter said. (See additional physician statements and MD contact phone #'s from around the state at bottom of this release.)
"Family physicians are the cornerstone of care in California's communities," Kakutani said. "Collectively, we immunize tens of thousands of children each year, help their parents manage seasonal illnesses like colds and flu, and treat their grandparents' diabetes and heart disease. Yet the State of California wants to compromise this care by making it harder and harder for physicians to afford to care for our patients."
"It often costs a physician more to provide medical care than he or she is paid under Medi-Cal," Kakutani explained. "We serve Medi-Cal patients because we believe everyone deserves high quality health care, regardless of the source of payment, but a physician's compassion for her patients should not be a liability -- we should not be repeatedly asked to donate our medical care."
"No clinic, family medicine residency program, or family physician's practice can weather the proposed Medi-Cal cuts without ill effects," Kakutani advised. "We need to pay our employees, pay our office rent and utilities, and pay our malpractice premiums. At some point continuing to see Medi-Cal patients becomes impossible. And, if we are expected to cut services, our patients will have difficulty getting the care they need."
California already has one of the lowest Medicaid reimbursement rates in the nation. Partly because of these low payment rates, California is in the midst of a primary care physician shortage, with more than 7 million people living in federally designated Health Professions Shortage Areas, including large parts of most counties. (Find your county on the state's Office of Statewide Health Planning and Development map -- Click on "Primary Care HPSA Designation Map": http://oshpd.ca.gov/HWDD/Research_Policy_Planning_GIS.html.)
The Governor's proposal calls for cutting $1.1 billion in state funds from Medi-Cal, California's Medicaid program, in fiscal year 2008-2009. This reduction would be accomplished primarily through a 10% provider reimbursement rate cut. Medi-Cal serves 6.6 million people in California -- 1 in every 6 people.
California Academy of Family Physicians
Statements Opposing Governor's Proposed 10% Cuts in Medi-Cal Payment
Kern County/Bakersfield: "In the surrounding rural areas of Lamont and Arvin, which are both federally designated Health Professions Shortage Areas, I repeatedly have seen new patients present to the clinic with long-standing medical problems whose longtime doctor had just literally closed his or her doors to Medi-Cal patients. It is already unsustainable for many local doctors to continue to provide care with inadequate reimbursement. The proposed cuts will certainly mean more closed doors for our communities, a sicker community and even busier emergency rooms." -- Michelle Quiogue, MD, Family Physician (323-356-7530)
Los Angeles County/Santa Monica: "I have been forced to limit my Medi-cal practice because of the bureaucracy and poor reimbursement. I do see occasional patients who have Medi-Cal coverage, but I see them for free. I'd rather just donate the service than deal with the paperwork and poor (if any) payment. It's also very hard to find specialists who will see Medi-Cal patients, so I have to turn away patients if it's likely that they will need specialty care. Further cuts will only make these problems worse." -- Lawrence Dardick, MD, Family Physician (310-586-9001)
Monterey County: "Medi-Cal cuts would significantly affect the population of Monterey County. Many of these patients are particularly needy of health care, and face barriers even when they do have physicians to see them. With Medi-Cal cuts, physicians like me who see Medi-cal patients outside of community clinics would be unable to continue this service. This would place even more of a burden on the clinics that see mostly indigent patients. Just this week I had a patient who suffered a catastrophic injury, lost her job, and had no treatment for her condition for six months due to lack of coverage until she obtained Medi-Cal coverage. These situations will only worsen with further cuts." -- Sumana Reddy, MD, Family Physician (831-663-0123)
San Diego: "Medi-Cal allows me to see patients whenever needed for ongoing medical care, immunizations, prenatal care and diagnostic tests. It also enables my patients to afford the medications I prescribe to treat and prevent illness. The proposed 10% cuts in Medi-Cal would directly result in less access to care, decreased immunization rates, increased visits to already overcrowded emergency rooms and a sicker population (due to decreased access to needed medications) in my community. Cutting Medi-Cal would ultimately result in more expensive and less effective health care." -- Albert Ray, MD, Family Physician (760-612-4591)
San Francisco: "As a family physician working at San Francisco General Hospital and UCSF Medical Center, I am acutely aware of the safety net that Medi-Cal provides to pregnant patients, poor families with children, and disabled patients, including many with HIV/AIDS. Medi-Cal allows them to receive care for acute and chronic illness, as well as preventive care that can help maintain their health and avoid costly and potentially life-threatening hospitalizations. A cut to Medi-Cal would inevitably lead to fewer private practices being able to afford to care for these patients, leading more and more of them to end up in the public health system. An influx of Medi-Cal patients into the public health system could provide an important challenge to this city's commitment to provide universal healthcare to its residents. Less state funding for healthcare will mean less access to prenatal care, fewer mental health services, fewer immunizations, less care for chronic illnesses such as asthma and diabetes, increased visits to overcrowded emergency rooms for medical conditions that could have been treated better, quicker, and cheaper in a doctor's office, more unnecessary hospitalizations, and a sicker population." -- Michael Potter, MD, Family Physician ([email protected])
Santa Clara County/San Jose: "Because of the state's low payment rates, my multi-specialty medical group does not accept new Medi-Cal patients. I can only continue to see my patients who out of necessity have become Medi-Cal patients. I also have difficulty finding specialists who take Medi-Cal insurance when patients need specialty care." -- Cynthia Cummings, MD, Family Physician (408-357-1328)
Sonoma County/Santa Rosa: "I saw 'Sally' this morning for her long-standing arthritis and worsening nerve pain. Already she has had an extremely difficult time finding any specialist who will see her, and has had to run up a big debt with various doctors who don't accept Medi-Cal at the current rates. Sally is struggling to care for her two kids, and keep functioning the best that she can. I can't help but worry about how she (and the thousands like her) will get any medical care, except by going to the Emergency Room, if the payment to physicians is cut even further. And remember--these are the people in our community who can least afford it." -- Bo Greaves, MD, Family Physician (707-477-9034)
Yolo County/Winters: "This cut would be devastating to patient care," said Carla Kakutani, MD, president of the 7,000-member California Academy of Family Physicians (CAFP). (530-795-4591)