Quote-of-the-day mailing list
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Subject: qotd: Enough specialists for Medicare, but not Medicaid
Date: Mon, 17 Dec 2012 12:04:16 -0800
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
Los Angeles Times
December 15, 2012
Healthcare crisis: not enough specialists for the poor
By Anna Gorman
By the end of the decade, the nation will be short more than 46,000
surgeons and specialists, a nearly tenfold increase from 2010, according
to the Assn. of American Medical Colleges. Healthcare reform is expected
to worsen the problem as more patients — many with complex and deferred
health needs — become insured and seek specialized treatment.
Many of the newly insured will receive Medi-Cal, the government plan for
the needy as administered through the state of California. Clinics
already struggle to get private specialists to see Medicaid patients
because of the low payments to doctors. Last week, an appellate court
decision that authorized the state to move forward with 10% cuts in
Medi-Cal reimbursement, which could make finding doctors for those
patients even more difficult.
"Specialists are paid so poorly that they don't want to take Medi-Cal
patients," said Mark Dressner, a Long Beach clinic doctor and
president-elect of the California Academy of Family Physicians. "We're
really disappointed and concerned what it's going to do for patient access."
In Los Angeles County, the sheer volume of poor or uninsured patients
needing specialist services has long overwhelmed the public health
system, creating costly inefficiencies and appointment delays that can
stretch as long as a year and half.
Patients' conditions often must be dire for them to see a neurologist,
cardiologist or other specialist quickly. Community clinics try to
bypass the backed-up formal government referral system by pleading,
cajoling and negotiating to get less critically ill patients moved up on
At times, clinic staff members are forced to work against one of their
key missions by sending patients to emergency rooms to increase the odds
of their seeing a specialist more quickly.
Comment: My career in private practice began with the introduction of
Medicare and Medi-Cal (Medicaid). At that time, I had no problems
referring Medicare and privately insured patients to specialists, but
the majority of them refused to see my Medi-Cal patients. The stigma of
"welfare patient" was there right from the beginning.
Quite a few years later, my Medicare patients continued to be accepted
without question, but some of the managed care patients were rejected,
and, of course, Medi-Cal patients continued to be rejected, except by a
few very dedicated specialists. Eventually with EMTALA, at least I could
force unwanted referrals for patients requiring specialized emergency
services by sending them directly to the Emergency Department. What a
terrible way to practice medicine.
As stated in my last message, there will be about 10,000,000 Medi-Cal
patients in California, once the Affordable Care Act is fully
implemented. Can you imagine the specialists suddenly opening their
doors and welcoming these patients into their practices?
I'll say it once again. If we had an improved Medicare single payer
system that treated everyone equitably, we would not have this problem.