Access, Clinic Finances, ED Overuse All Major Concerns for CMA

With health care reform and the state’s cutbacks and reorganization of its health care system, the practice of medicine in California is about to undergo major changes. California Medical Association officials have serious concerns about some of those changes.

“Yes, we are in a budget crunch, and yes, money is tight,” said Doug Brosnan, an emergency department physician and a member of the CMA’s board of trustees. “But there is suffering. Patients are suffering because they lack access to basic services.”

Brosnan was part of a group of CMA officials who met with reporters on Friday in Sacramento to talk about California’s recent spate of budget cuts to health programs and the outlook for reform after the Supreme Court’s decision to uphold most of the Affordable Care Act. CMA officials said they are concerned about the state’s efforts to reorganize existing services — such as the duals demonstration project, or the shift of 873,000 children from the Healthy Families program to Medi-Cal managed care.

The Healthy Families shift has the potential to increase ED traffic, Brosnan said, in part because it has the potential to disrupt where children and their parents get care, and in part because of the potential increased workload for providers who accept Medi-Cal patients. If preventive services become disrupted for children or their parents, that means more trips to the ED, Brosnan said — not for those preventive services, but to deal with the acute problems created by not getting preventive care, he said.

“I have patients coming into the ED all the time, and they’re not there to access primary care services, they’re coming into the ED sick,” Brosnan said. “There’s a misconception they’re coming in for primary care services, and that couldn’t be further from the truth. Less than 10% of these patients are non-emergent.”

Between the pending Medicaid expansion and the shift of almost a million children from Healthy Families to Medi-Cal managed care, the state is looking at a future of almost 1 in 4 Californians on Medi-Cal, CMA officials said. There is a federally-enhanced Medi-Cal reimbursement rate for primary care providers during the first two years of ACA, but it could be difficult for primary care providers to change their practices, not knowing what will happen after those two years, said Lisa Folberg, vice president of medical and regulatory policy at CMA.

“You can only take so many Medi-Cal patients before you go out of business,” Folberg said. “A lot of solo practitioners will either have to join a group or go out of business.”

The state could help this dire picture by moving more slowly with the Healthy Families population, for example, ramping up to the task a little more, said Molly Weedn, the CMA’s director of media relations. There are opportunities among the challenges, she said.

“The economics of medicine are changing,” Weedn said, “and right now there’s a lot of chaos and a lot of concern, but innovative solutions could emerge from this. One of the things we’re hoping for is [expanded use of] the medical home. There are some hopeful solutions out there.”

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