June 30, 2008
Medi-Cal Cuts Place Millions of Patients’ Care in Jeopardy on July 1, Family Physicians Say
Family medicine physicians across the state are bracing for the health care crisis facing their patients when a 10% reduction in physician payments takes effect on July 1. "The State of California is putting the health of millions of patients at risk with these Medi-Cal cuts," said Jeffrey Luther, MD, president of the 7,000-member California Academy of Family Physicians (CAFP).
"Some doctors are simply closing their doors to Medi-Cal patients," he said, "because the cost of providing care is so much higher than the State's payments. It's not the patients' fault, but they are the ones who will suffer when they cannot find a doctor."
The State is reducing Medi-Cal payments to physicians, clinics, hospitals and others on July 1, and also is delaying payments for weeks, citing state budget shortfalls as the reason. In addition, a 10.6% federal Medicare cut to physician payments also takes effect on July 1. "As small businesses, we cannot afford the cuts," Luther said. "As patient advocates, we cannot stand by silently watch it all happen." CAFP is one of nine organizations suing the State to stop the Medi-Cal payment cuts.
The Medi-Cal program, this state's version of Medicaid, provides health care coverage to more than six million disabled and low-income Californians. Medi-Cal payment rates now are the lowest in the nation, and for several years have not kept pace with the escalating costs of providing medical care.
"One measure of a good government is how well it provides for its most vulnerable people, and by that measure California is failing," Luther said. "Decreasing access to health care for millions means the health status of Californians will decline, as patients have difficulty obtaining care at already overcrowded emergency rooms and clinics. Many will forego the preventive and chronic-illness care that can keep them healthy. Some won't seek care at all until their illnesses reach a crisis point, and then the care will be much more expensive and the outcomes much more uncertain."
In the statements below, family medicine physicians from urban and rural areas alike describe the problems facing their patients when the Medi-Cal cuts take effect tomorrow:
"Health care for Medi-Cal patients in Fresno County is in absolute crisis, and it's getting worse by the day," said family physician Adriana Padilla, MD. "My private practice already is unable to accept Medi-Cal patients because of the low payment rates. Now, one of the premiere clinics that does see Med-Cal patients is in financial jeopardy.
"Because of the turmoil and uncertainty, I'm not sure whether to refer uninsured patients to this clinic," Padilla said. "Yet, I am seeing an increasing number of uninsured patients who need services - including important cancer screening tests such as mammograms and pap smears - available to them only at the FQHC center.
"The Medi-Cal rate cuts will further erode the safety net in Fresno County as more and more doctors become unable to afford to see Medi-Cal patients," she warned. "Already the only specialists here who will see Medi-Cal patients are physicians who contract with the medical education training center. Waits for services already run several months there and will now grow even longer."
Monterey County - Salinas & Prunedale
"The 10% cuts directly threaten our ability to keep our doors open," said Sumana Reddy, MD, a family physician whose small-group practice delivers care in Salinas and Prunedale. "On top of these cuts, the state may also delay payments by several weeks, and cash flow is our most difficult financial challenge.
"Despite tremendous challenges, we have always continued to see patients as they changed insurances, whether Medi-Cal or another source," Reddy explained. "We serve an ever-increasing number of patients, particularly children, as other practices stop taking new Medi-Cal patients. Given our depressed local economy and the increasing difficulty of meeting our overhead costs, the Medi-Cal cuts are just too large in an already under-funded program. It's sad that the government is jeopardizing patients' health in this way. We have treated our patients and their extended families for many years, and would hate to see them face the barriers to care that would result from yet another practice becoming unable to afford caring for them. Where will they go?"
Contra Costa County
"People living in the impoverished community where I work now will have even fewer doctors to turn to," said Cynthia Carmichael, MD, a family physician who works at a Contra Costa County health center in North Richmond. "Physicians in private practice will have to limit the number of Medi-Cal beneficiaries they accept as patients because the program doesn't pay enough to cover the costs of providing care. That means our county's unique, but already overburdened, program that provides quality primary care for uninsured patients will likely become increasingly inaccessible.
"It's such a devastating cycle," she explained. "Because many patients will postpone getting the care they need, the Medi-Cal cuts will directly result in less access to prenatal care, decreased immunization rates, increased visits to already overcrowded emergency rooms, and overall, a sicker population. Cutting Medi-Cal will ultimately result in more expensive and less effective health care."
Santa Cruz County
"Making the 10% Medi-Cal cuts is a short-sighted approach that will only increase health care costs," said Hannah Farquharson, MD, who practices in Santa Cruz. "By balancing the budget on the backs of low-income people, we are 'picking' on the most vulnerable. Decreasing Medi-Cal patients' access to a primary care medical home is contradictory to saving the budget. Instead, it will increase costs as patients seek care in emergency rooms for non-emergent illnesses like the flu, colds and strep throats. It will also result in an increased severity of illnesses for patients who won't have access to necessary preventive and chronic-illness care. Why force a patient to wait for a heart attack when we have the excellent medical knowledge to prevent it?"
"My office was forced by economics to stop seeing new Medi-Cal patients several years ago," said family physician Steven Green, MD, who practices in San Diego. "We intend to keep seeing existing patients if they go onto Medi-Cal, but even doing that may become impossible with the new 10% cuts.
"Continuity of care is critical, especially for patients with chronic conditions," Green explained. "Several other medical groups here, however, are also rethinking whether they can continue seeing Medi-Cal patients because the survival of their practices is at stake. If current Medi-Cal patients can't get outpatient care in physician offices, they will have to resort to using emergency rooms. The wait times at ERs are already long, and adding more patients will greatly increase the problem. More expensive care in a more expensive setting - that's the 'cost saving' Medi-Cal cuts actually bring. This crowding of the ER will hinder everyone's access to emergency care, not just those with Medi-Cal.
"Another consequence of poor office access for Medi-Cal patients is they will delay getting care and ultimately will be much more ill by the time they brave the ER, again costing more in terms of both dollars and human suffering."
EDITOR'S NOTE: Several family physicians are available for media interviews. Contact Catherine Direen, 415/595-7050.
Bakersfield: Michelle Quiogue, MD Central Valley-North: Julian Delgado, MD Contra Costa County: Cynthia Carmichael, MD Fresno County: Adriana Padilla, MD Los Angeles & Statewide: Jeffrey Luther, MD, President Modesto: Eric Ramos, MD Monterey County (Salinas & Prunedale): Sumana Reddy, MD Orange County: Thomas Bent, MD Sacramento: Candace Lawson, MD San Diego: Steven Green, MD San Francisco: Michael Potter, MD San Jose: Cynthia Cummings, MD Santa Cruz: Hannah Farquharson, MD Santa Rosa: Lyman "Bo" Greaves, MD Winters (near Davis): Carla Kakutani, MD
About the California Academy of Family Physicians
Since 1948, CAFP has been analyzing and disseminating trends and information to assist California's family physicians in their practices. With more than 7,000 members, including active practicing family physicians, residents in family medicine, and medical students interested in the specialty, CAFP is the largest primary care medical society in California, and the largest chapter of the American Academy of Family Physicians. Family physicians are trained to treat an entire family's medical needs, addressing the whole spectrum of life's medical challenges. FPs serve a broad base of patients in urban, suburban and rural areas, often in California's most underserved areas.
For more information: www.FamilyDocs.org.