MEDI-CAL: Inner-City Doctors Can’t Afford To Meet Program’s Requirements
Doctors who serve Medi-Cal members in "some of California's poorest inner cities could be left out of the state's burgeoning $2.3 billion-a-year" managed care program, American Medical News reports. These "safety-net providers," as they are called, could face "the loss of not only the majority of their patients but a large part of their incomes" if they are unable to comply with new standards. In order to enter the state's managed care system, HMOs say these doctors must "install computerized patient-tracking systems that can manage utilization and cost," and make renovations to comply with the Americans With Disabilities Act, such as building handicapped parking spaces, patient access ramps and elevators. But most of these providers say they can't afford these improvements. L.A. Care Health Plan conducted an audit that revealed 30% of these safety-net providers are "inadequately prepared to meet contracting standards."
American Medical News reports that the state has created a loan program for doctors to make the improvements, but "not a single one has received the loan thus far." Most of the doctors say they can't afford to take out a loan either. "Without assurances that we'll be able to pay the money back, it's risky," said Dr. Stephen Levine, most of whose patients are Medi-Cal recipients. Levine, who runs a mobile medical unit out of his car, said "managed care will not pay him enough to meet his current overhead, let alone the loan's debt service." But the current problem points to deeper issues in the Medi-Cal managed care problem, American Medical News notes, such as "shrinking state reimbursements" for Medi-Cal, "catching up with the medical world's conversion to managed care" and "trying to sell managed care in poor areas." Dr. Robert Beltran said, "I'm getting 20 cents on the dollar under fee-for-service. Managed care pays the equivalent of 10 cents on the dollar. What good does a loan do when nobody's addressing the real problem?"
Michael Dowell, an attorney that does Medi-Cal work, said that the safety-net providers traditionally have been "ignored" by the managed care community, but now are being targeted to take on Medi-Cal patients. Dr. Steven Feig, a pediatrician who treats Medi-Cal patients, said he worries that "HMOs will arbitrarily assign enrollees to certain favored providers." Doctors also fear that inner-city doctors would lose patients to "better-equipped practices in better areas," with healthier patients ending up at the practices in better areas and the sicker patients with the inner-city doctors. As a result, inner-city doctors would be being "driven out of the system" because of the capitation risks associated with sicker patients (Kim, August 24/31 issue).