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Medi-Cal Reimbursement Tops Policy List

The California Medical Association gathered in Sacramento last weekend, and the new CMA president came up with his own variation on the real estate agent motto:

It’s about funding, funding, funding.

“We would like to see physicians be able to maintain a viable practice, first and foremost,” new CMA president James Hinsdale said. “Physicians are being squeezed by Medicare, and squeezed by Medicaid [and by California’s Medicaid program, Medi-Cal].”

Those programs have cut reimbursement rates to a point where physicians lose money treating subsidized patients, Hinsdale said. And with health care reform, he said, there will be millions of new Medi-Cal patients wanting care.

“We’re pushing everyone onto Medicaid, while California is close to dead last in the country in Medi-Cal reimbursement,” he said — which means that physicians will feel pressure to do more work, for less money.

“It’s so simple, it hurts,” Hinsdale said. “Funding. It’s about funding.”

Part of the reason reimbursements were such a hot topic this week is because of looming Medicare cuts — about 23% in cutbacks due on Dec. 1, and another 6% trimmed Jan. 1.

Hinsdale, a trauma surgeon from San Jose, was elected at the meeting to serve as president of the 35,000-member organization. He said the direction of most physicians during the conference was similar: During tough times, physicians need to keep focused on patient care.

“The theme is, number one, despite the turmoil of reform, doctors have to focus on being the best physicians possible,” Hinsdale said.

“Mainly we need to stay on an even keel to be good doctors,” he said. “It’s true, we’re working harder for less money, and that’s what they see. But they also want to do what’s best for patients, despite that difficulty. The doctors are all in survival mode, but we are all about getting adequate care for the citizens.”

As an example, he pointed to CMA-sponsored legislation this year to make sure all children could get vaccines. That proposed law passed the Legislature, but was vetoed by the governor.

“The governor vetoed funding for vaccines for little kids,” Hinsdale said. “We were, of course, disappointed.” The CMA is likely to pursue that legislation again, he said.

There were other policy milestones, he said: “Getting sugar water out of the cafeterias, violence prevention, ensuring that people will get access to care. It all boils down to access to care,” he said.

Hinsdale fears the combination of fewer medical students going into primary care and more physicians giving up their practices in California will mean an even steeper physician shortage than there is now. Add in the higher number of patients needing services, divide by the low Medi-Cal reimbursement rates, and you have a bleak equation on your hands, he said.

“The math is pretty stark,” Hinsdale said. “We’ve been beating the pots and pans to entice more docs to practice here, and yet we don’t reimburse them. It just doesn’t add up.”

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