Not enough doctors in Medicaid, Ill. director says

Illinois Medicaid Director Julie Hamos is warning that there won't be enough doctors to treat the expected surge next year of new Medicaid patients unless more physicians participate in the healthcare program for the poor.

“This is the thing that keeps me awake at night,” Ms. Hamos, the director of the Illinois Department of Healthcare and Family Services, which administers Medicaid, said last week. “Where are the providers to serve all these new people?”

About 1.2 million uninsured people in Illinois are expected to gain some form of health insurance coverage on Jan. 1 under the landmark overall of healthcare. About half of those people will be newly eligible for Medicaid.

“We don't have enough doctors in the pipeline,” Ms. Hamos said during the keynote speech at an April 4 Institute of Medicine of Chicago leadership breakfast.

Many physicians have historically shunned the program, in part because of its low fees. Roughly 16 percent of the state's 47,000 doctors aren't even signed up for Medicaid. 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 published last year.

“There's a definitely a form of discrimination against patients on Medicaid,” said Dr. Elbert Huang, who co-authored a study published in February in medical journal Health Affairs, about how the demand for primary care services might exceed the supply.

Up to 7,000 more primary care physicians are needed nationwide to meet the demands of the projected 29 million people who will gain coverage next year.

While the influx of patients likely won't be disruptive across the country, the shortage will be felt in areas with a large number of uninsured and few doctors to begin with, said Dr. Huang, director of the Center for Translational and Policy Research of Chronic Diseases at the University of Chicago.

To fill the gap, Ms. Hamos is encouraging doctors to take advantage of the higher reimbursements Medicaid is temporarily paying for primary care services.

Board-certified pediatricians, internists and family medicine practitioners are among those eligible for the higher fees, according to a March 4 notice published by the Department of Healthcare and Family Services. Physicians who aren't certified in those specialties are also eligible if at least 60 percent of their annual billings are to Medicaid.

The temporary rate change makes Medicaid reimbursements equal to the higher fees paid by Medicare for about 180 billing codes for primary care services, such as vaccinations and check-ups, said Dr. Arvind Goyal, medical director for the HFS division of medical programs. Rates vary per service, and the increase only covers services rendered from Jan. 1 through Dec. 31, 2014, when the higher rate is set to expire.

Fees vary based on the nature of the treatment. But the $50 fee for a routine check-up is now nearly double, said Dr. Yasmeen Ansari, who runs a clinic in west suburban Wood Dale, where she is the only doctor.

Up to 60 percent of her patients are on Medicaid, she said, adding that the nearly four-year-old clinic generally falls about $50,000 a year short of breaking even.

“It's definitely going to help us in terms of being able to see more patients and provide more care,” she said.

The Affordable Care Act gives states the option of expanding Medicaid. Illinois lawmakers have yet to approve the expansion, which is supported by Gov. Pat Quinn.

"Not enough doctors in Medicaid, director says" originally appeared on Crain's Chicago Business.