No Doctors for Beebe's Patients?

Curtis Coleman, Contributing Author: On Monday of this week, the U.S. Department of Health and Human Services (HHS) notified Arkansas Governor Mike Beebe that the State is getting conditional approval of his proposal to “develop a new payment system for its Medicaid program.” State officials project that Arkansas’ Medicaid program that serves about 775,000 Arkansans (1/4th of the State’s total population) will face a $60 million to $80 million shortfall in the fiscal year that begins on July 1, 2012 and greater deficits in coming years.

On February 11, 2011 Beebe sent a letter to Kathleen Sebelius, Secretary of HHS, requesting permission for the State to drop the State’s fee-for-service system, moving to payments for something Beebe’s proposal calls “partnerships of local providers to act as health homes” and “reimbursement for episodes of high-quality care.”

While Beebe’s Feb. 11 proposal (released to the public in early March) is lacking in details and fails to define or describe terms such as “health homes” and “episodes,” subsequent public statements by the Governor’s staff and state agency directors have made it increasingly clear that the Governor’s plan is to make a single “bundled” payment to a group of health care providers (such as a group of doctors, hospitals, clinics, etc.) for treatment of a specific condition such as diabetes. The group will then somehow divide the payment among themselves.

According to a recent story in the Arkansas Democrat-Gazette, John Selig, the state Department of Human Services director, said “the only alternative is to contemplate cutting benefits, provider payments or restricting eligibility.” It is clear that Beebe and Selig have selected door #2, cutting provider payments.

David Wroten, executive vice-president of the Arkansas Medical Society, has made it clear that physicians across the State are extremely opposed to Beebe’s plan. Wroten said that providers are being consulted only after “the broad outlines of the plan were developed” and are only now being asked to “consult on the logistics of implementation.”
If the State wants the support of physicians, Selig didn’t help that cause with his seeming slam of opposing providers, suggesting that only those who do not provide “effective services” would oppose the new plan. “It really shouldn’t be a threat to any provider who is providing effective services, “ the Dem-Gaz quotes him as saying.

With Medicaid payments already the lowest providers receive, further cutting payments to providers will indisputably be counter-productive. More and more doctors are refusing to see Medicaid patients. And there will be fewer and fewer doctors to see any patients. Wroten was right when he told the Dem-Gaz, “If ‘bundled payments’ are put in place, recruiting doctors to the state will become more difficult and many doctors already in practice will stop accepting Medicaid patients.” And we’ll be seeing a lot more stories like this:

LAFAYETTE, La. — Eight-year-old Draven Smith was expelled from school last year for disruptive behavior, and he is being expelled again this year. But his mother and his pediatrician cannot find a mental health specialist to treat him because he is on Medicaid, and the program, which provides health coverage for the poor, pays doctors so little that many refuse to take its patients.

Surely we can learn something from Massachusetts’ RomneyCare (the harbinger of Obamacare), where so many doctors have left the state the waiting period to see any doctor has doubled, sending many patients back to high-cost emergency rooms –exacerbating the very phenomena Obamacare, RomneyCare and BeebeCare are intended to prevent.

Medicaid, Medicare and health care in America desperately need reform. But it seems that in every instance, 50% of the essential stakeholders in the equation are left out of the development of equitable solutions – health care providers. Who else could possibly understand more clearly the burgeoning problems and their most effective corrections than doctors, nurses and hospital administrators? Their consistent exclusion from the process can only be indicative of the intent of an overreaching government to assume the health care decisions for all Americans.

Beebe’s plan may have a new and unexpected opponent. It seems someone in the Obama administration has figured out that continuing to reduce payments to health care providers is drastically reducing the number of available providers. The New York Times reported this week that the Obama Administration is proposing a rule that it would make it “much more difficult” for states to cut Medicaid payments to doctors and hospitals. It is unclear if or how this will affect Beebe’s plan.

If we chase this rabbit all the way to its hole, the picture is more troubling. If health care providers continue to be squeezed and inadequately reimbursed, they will inevitably increasingly continue to refuse to accept Medicaid and Medicare patients. They will be able to refuse these patients only as long as there are other payment options, such as private insurers. The inexorable question becomes, “How long will the government tolerate the scenario in which patients with private insurance have doctors and patients with government insurance do not?”

The government already does not tolerate this scenario for patients 65 and above. If when reaching age 65 you plan to draw on the payments you’ve made to the social security system all of your working life, then Medicare must become your primary health insurance plan. If you refuse Medicare, you will not be allowed to draw your social security benefits. How long will those under age 65 be permitted to have a choice of their private insurance and its benefits, a choice of their health care providers – and the ability to make their own personal health care decisions?

Give me a team of doctors, nurses and hospital and clinic administrators and a few months. We’ll give you a fix for Medicaid and Medicare Arkansans can live with.
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Curtis Coleman is the President of The Curtis Coleman Institute for Constitutional Policy and contributing author to the ARRA News Service.

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