Cutbacks in Medi-Cal Could Drive Away Doctors

Medi-Cal patients may find it more difficult to get outpatient treatment for their ailments after a 10% cut in some Medi-Cal payments ordered by the Deukmejian Administration goes into effect Feb. 1, medical leaders say.

Not only is the number of private physicians willing to see Medi-Cal patients expected to dwindle as a result of the cuts in their fees, but the patient load at already overburdened facilities like UC Irvine Medical Center is likely to increase, according to health authorities.

State Budget Shortfall

The 10% cut in payment for services applies to physicians, dentists, hospital outpatient departments and a number of other health professionals who serve the state’s 3 million Medi-Cal patients. The Deukmejian Administration said last month that it is making the cuts to help counterbalance a projected $900-million state budget shortfall, $280.7 million of which will be for Medi-Cal services.

While the cut in fees to medical providers is expected to save only $18.7 million--minuscule compared to the program’s $5 billion budget--some medical leaders see it as adding one more barrier for people on Medi-Cal who already have trouble finding doctors willing to treat them.

“We are fearful that doctors will stop seeing Medi-Cal patients,” said Thomas Uram, director of the Orange County Health Care Agency.

How severe the upcoming 10% cuts will prove to be may depend on how many private doctors who treat Medi-Cal patients phase out of the program, said health professionals.

In Orange County, the cuts primarily will affect doctors whose patients include the poor living in central Orange County, said Michael T. Kennedy, Orange County Medical Assn. president.

“The cut in reimbursements mainly affects those doctors who have minority practices, and it’s most cruel to them,” Kennedy said. “They won’t be able to get paid at all.”

Kennedy, a surgeon with an affluent practice in Laguna Hills, said that even when he does see a Medi-Cal patient, Medi-Cal is less than ambitious about reimbursement.

“If I do an appendix operation I would get paid about 25% of my normal fee,” he said. “Many doctors don’t even bill Medi-Cal because they know they won’t get paid.”

John Gilwee, director of the Orange County office of the Hospital Council of Southern California, said hospitals in central Orange County, including Santa Ana, Garden Grove and Anaheim, may have to discontinue some services when the impact of the budget cuts begins to “overload some hospitals which can no longer carry the load.”

First to close may be emergency rooms at hospitals that receive a large number of Medi-Cal patients, Gilwee said.

“As reimbursement rates decline, it results in hospitals with far more limited resources,” Gilwee said.

Impact Predicted

Los Angeles County, which has county hospitals to serve the poor, expects to lose about $800,000 between February and June 30 because of the cuts, said Irv Cohen, assistant director of finance for that county’s Department of Health Services.

But in Orange County, which has no government hospital, the problem is becoming “enormous,” said Dr. Howard Waitzkin, professor of medicine and social sciences at UC Irvine Medical Center.

“The bottom line is that any further cutbacks by the state will exacerbate the problem,” he said.

Without a county hospital, UC Irvine serves many of the county’s poor who rely on Medi-Cal. The medical center is frequently referred to as a dumping ground for patients turned away by other facilities. About 70% of UC Irvine’s patients are paid for by county, state or federal government funds. And, about 40% of the county’s working poor go to UC Irvine Medical Center or one of its clinics, although more than 30 other hospitals in the community have contracts with the county to treat them, according to hospital officials. Those hospitals also will be hurt, Uram said. “You’re getting only 70 cents on the dollar now for your costs, and now it’s going to be 10% less.”

Dr. Jack McCleary, president of the Los Angeles County Medical Assn., said hospitals also “may see sicker patients because more people will put off seeking care in the early stages of an illness.”

Statewide Problem

The problem is similar statewide, according to Dr. Gladden Elliott, president of the California Medical Assn.

“The availability (of doctors) over a wide geographical area will be spotty,” he said.

Citing high blood pressure as an ailment that is easy for patients to ignore because they do not feel ill, Dr. Clyde Oden, president of the Watts Health Foundation, said delaying care could likely lead to a stroke or other medical problem that would end up costing the Medi-Cal program far more than an outpatient visit. Charges for inpatient hospital services are among those exempted from the 10% rate reduction. Among other exempt providers are nursing homes, rural health clinics, state-county mental health programs and obstetricians.

Children under 14 years of age are expected to be especially vulnerable if more dentists quit the program because of the fee cutback. Children make up one-third of all Medi-Cal beneficiaries. According to a California Dental Assn. spokeswoman, “Fewer and fewer dentists are willing to treat Medi-Cal patients” because the program now pays about 40% of regular dental fees and most counties have no dental programs for patients to fall back on.

Medical specialists, such as orthopedists, will also be further discouraged from participating in the program, predicted Dr. Gary Krieger, a San Pedro pediatrician. “There is no orthopedist in San Pedro who will see a Medi-Cal patient,” he said.