In what will prove to be a huge roadblock for healthcare reform implementation in California, the Centers for Medicare & Medicaid Services (CMS) approved yesterday a state plan amendment (SPA) that will reduce Medi-Cal provider reimbursement rates by 10 percent.
"CMS has chosen to ignore its own law with this decision," said Dustin Corcoran, CEO of the California Medical Association (CMA). "The President built his expansion of access to care on the Medi-Cal system and with this decision his administration has effectively destroyed it. Adding three million patients to Medi-Cal while reducing physician resources is nothing but a recipe for disaster."
Just last week, CMA filed a petition with CMS asking that correctiveaction be taken to address current reimbursement rates and access standards.
"What we're seeing now, is that Medi-Cal patients are already having a tough time getting access to care," James T. Hay, M.D., CMA president said. "With these cuts, physicians will only be reimbursed $11 per Medi-Cal patient visit, when it costs the physician several times that to provide. Physicians will be forced to reduce the number of Medi-Cal patients they accept, if they can continue to see any at all. We want to be able to treat these patients and we regret that the federal government is making it impossible."
Recent data from the California Office of Statewide Health Planning and Development, compiled by the American College of Emergency Physicians, shows a significant increase in emergency room visits since 2005 by Medi-Cal beneficiaries. Specifically, in Fresno County, ER usage has increased from 40 percent to over 46 percent. On average, ER use by Medi-Cal patients increased 30 percent between 2007 and 2009 (most recent reporting period). This demonstrates that Medi-Cal beneficiaries are already being forced to seek necessary care in the ER when they can't find a physician.
And preliminary results from SDCMS' bi-annual San Diego County Physician Workforce and Compensation Survey indicate that from among the 61 percent of physicians in the region who currently accept Medi-Cal patients:
* 35% of medium-group physicians (groups of five to 150 physicians) would accept fewer Medi-Cal patients, accept no new Medi-Cal patients, or eliminate Medi-Cal patients from their practices if rates are cut by 5%;
* and fully 79% of solo and small-group physicians (groups of one to four physicians) would accept fewer Medi-Cal patients, accept no new Medi-Cal patients, or eliminate Medi-Cal patients from their practices altogether if rates are cut by 5%.
Yesterday's 10 percent cut by CMS is bound to exacerbate a system already teetering on the edge of collapse.
"The approval of provider payment reductions will ensure overcrowding in emergency rooms and will absolutely mean less access to care for all Californians," Corcoran added. "Of course these are tough budget times, but the Department of Health Care Services and CMS are balancing their budgets on the backs of the most vulnerable Californians."
This was a secretive process where the data was not shared with providers and other stakeholders and the results will cause irreparable harm to patients by forcing physicians out of the Medi-Cal program.
The San Diego County Medical Society (SDCMS), the professional association for physicians in San Diego County, founded in 1870 and chartered by the California Medical Association, currently counts approximately 2,700 practicing physicians within the county as members. SDCMS — "Physicians United for Healthy San Diego" — fights for access to quality healthcare for all San Diegans.
The California Medical Association (CMA) represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.