The Medicaid money trail?

Crains reports:

“Doctors are shunning Medicaid patients because of low fees, a trend that is likely to become a crisis in less than two years, when the ranks of patients are expected to swell.

Budget talks in Springfield last week to reduce a $2.7 billion annual deficit in the health care program for the poor won’t help ease the chronic shortage of doctors willing to treat patients at rates that are among the lowest in the nation. Fees are one reason many Chicago-area specialists don’t make appointments with Medicaid patients, two studies have found.

Roughly 16 percent of the state’s 47,000 doctors aren’t signed up for the program. Even among those who are, the overwhelming majority infrequently see patients, leaving the care concentrated in the hands of a few, according to a Crain’s analysis of payment records.

About 25 percent of Medicaid doctors account for just 0.4 percent of the $2.8 billion paid from 2009 through 2011 and make less than $1,400 a year in the program, Crain’s finds. At the other end, the top 10 percent of Medicaid earners received more than 55 percent of the total payments, making at least $70,000 a year, the analysis shows.

The shortage of doctors, particularly specialists, is likely to get worse, experts say. In 2014, an estimated 611,000 additional residents will be eligible for Medicaid, a 22 percent increase over the 2.7 million people with full benefits under the Illinois program. Meanwhile, the rising number of aging baby boomers already is increasing demand for doctors.

“You have a huge supply-and-demand problem,” says Dr. David Ansell, chief medical officer at Rush University Medical Center and a member of the independent board of the Cook County Health and Hospitals System.

Take a closer look at the state of Medicaid in Illinois

To measure doctors’ participation in the Illinois Medicaid program, Crain’s analyzed Department of Healthcare and Family Services data containing more than 95,000 payment records. The claims were submitted by about 32,000 doctors in the 2009-11 fiscal years. Providers can submit claims up to 12 months after the June 30 end of the state’s fiscal year; the 2011 data contain about 90 percent of the total payments, Crain’s estimates.

The Crain’s analysis reveals:

• The median annual payment ranged from $8,000 to $9,000 per doctor between 2009 and 2011. (The median is the point at which half of the doctors received more money and half received less.)

• The average annual payment ranged from $28,000 to $30,000 per doctor.

• The top 5 percent of doctors made at least $122,724 in 2010, comparable to other years.

Last week, the Illinois General Assembly voted to cut about $1.6 billion from the Medicaid budget, which is $14.3 billion in the current fiscal year. The Legislature at press time on Friday was still considering a bill that would help close the deficit by increasing the cigarette tax and raising fees on hospitals with few Medicaid patients.

Physicians’ fees were not touched because of a 2005 consent decree issued in a civil rights case against the program, says Rep. Sara Feigenholtz, D-Chicago, a key negotiator on the Medicaid budget.

Officials with the Department of Family Services decline to comment because of the ongoing negotiations in the Legislature.

Dr. Deborah Edberg is first vice president at the Illinois Academy of Family Physicians. Photo: Stephen J. Serio

Each state sets its own Medicaid rates. Illinois’ rates are among the lowest in the nation, according to a study of Medicaid reimbursement from 2003 to 2008 by the Menlo Park, Calif.-based Kaiser Family Foundation.

“For a private physician in practice … it’s just that if you take too many Medicaid patients, you can’t keep your doors open,” says Dr. Deborah Edberg, first vice president at the Lisle-based Illinois Academy of Family Physicians.

As a result, Chicago-area specialists are six times more likely to deny appointments to parents of children on Medicaid than parents with private insurance, according to a study published in 2011 in the New England Journal of Medicine. A study published last year in the journal Pediatrics reached a similar conclusion.

The extension of Medicaid is a key part of President Barack Obama’s 2010 landmark health care law. A U.S. Supreme Court decision striking down the act won’t change the lopsided doctor participation in Illinois. The federal government will fund the initial expansion, but that money will not close the gap between Medicaid and Medicare rates here.

The law will make those rates for primary care doctors equal for two years, beginning in 2013. That money will not raise payments to specialists, who accounted for about 60 percent of Medicaid payments to doctors in Illinois in 2009-11.

“You can’t deliver quality care without some specialties,” says Benn Greenspan, a professor of health administration at the University of Illinois at Chicago and former CEO of Sinai Health System in Chicago.”