Salt Lake Tribune, United States

Fewer Utah physicians accepting Medicaid
By Kirsten Stewart

The Salt Lake Tribune
Article Last Updated: 09/15/2007 10:41:06 AM MDT

PROVO — Sergey Sargsyan has lost 80 pounds since his
symptoms began more than three months ago. He’s in
pain and getting weaker.
Emergency room visits and surgery to remove gall
stones have done little to help. Doctors say he needs
a specialist to fine-tune his diagnosis.
But finding one willing to accept Medicaid as
payment has been an exercise in futility, said Susanna
McPhilomy, the 77-year-old’s daughter. "The first
question isn’t, ‘How can we help you?’ " she said,
"but ‘What type of insurance do you have?’ "
Sargsyan is not alone. Health care experts are
seeing the first of what they say could become
widespread lack of access to care for Medicaid
patients.
In Utah, the number of doctors who accept Medicaid
is shrinking.
In fiscal year 2007, which ended in July, 3,540
physicians billed the state-run health insurance
program for their services.
Due to the way the state keeps records, a small
number of these providers may be listed twice. But
that is also true for the number of doctors who billed
the state in 2000 — which was 4,210, revealing a 19
percent drop in seven years.
Dentists are also in short supply, down 14 percent
from seven years ago, state Health Department data
show.
"I was crying." Health officials say the shortage
hasn’t reached a crisis.

Patients aren’t being turned away, though they may
have to hunt around for a doctor willing to see them,
or wait weeks for an appointment, said Utah Medicaid
director Michael Hales.
There are roughly 4,700 doctors estimated to be
practicing in Utah.
But that’s small comfort for people like
McPhilomy, who said her father’s condition, chronic
urinary retention possibly stemming from an enlarged
prostate, could be lethal if left untreated.
Sargsyan’s problems started in mid-July. He was
having problems urinating, so McPhilomy took him to
the emergency room where doctors inserted a catheter.
The hope was the problem would resolve itself. It
didn’t.
On a return visit days later to the ER, a doctor
at Utah Valley Regional Medical Center referred
Sargsyan to a urologist for testing to see if his
health woes stemmed from an enlarged prostate.
McPhilomy scheduled an appointment with a doctor
who said he accepted Medicaid. But when the family got
to the American Fork office of physician Vernon
Calhoon, she said, they were turned away.
When McPhilomy objected, the receptionist
threatened to call police, she said.
"I was crying because I felt so humiliated. Here
was my father, sweating and very weak and I was
helpless to do anything about it," said McPhilomy. "If
they were not serving Medicaid patients, they should
not have scheduled an appointment and dragged my poor
sick father from Provo to American Fork."
None of Sargsyan’s care providers would comment,
citing federal privacy laws.
A secretary in Calhoon’s office, who refused to
give her name, said, "We didn’t refuse to see the
family. We explained we’re not on their panel of
providers and they got all upset…These days you have
to be careful. People say they have insurance, and
they don’t."
Medicaid patients in Utah are covered by three
different insurers, each with their own doctors.
Relying on good will. Thanks to a referral from a
friend who is a pediatrician, McPhilomy was able to
get her father into a urologist on August 15, but only
the physician’s assistant would treat him.
Later, her father saw a gastrointestinal
specialist for a colonoscopy, a biopsy and treatments
for bacterial infections.
But Sargsyan, an Armenian-born U.S. citizen, still
hasn’t seen a urologist, is still wearing a catheter,
and his urinary problems have yet to be diagnosed.
"How can this country deny its sickest and oldest
citizens help? It’s discrimination. It’s immoral,"
said McPhilomy.
Data on urologists confirm McPhilomy’s
frustrations. There are 26 doctors in Utah who do
urological surgery on Medicaid’s provider rolls. In
2006, only two billed Medicaid. In 2007, none did.
Doctor groups and health care reformists say
there’s an easy fix: increase Medicaid reimbursement
rates. Medicaid, which provides care to the poor, but
also the disabled and some elderly, pays health care
providers significantly less than Medicare and private
insurers.
But state health officials say it’s not that
simple.
"You also have to factor in supply and demand,"
said Hales. The general supply of doctors is dwindling
as more reach retirement age and fewer graduate from
medical school. Meanwhile, aging baby boomers feed a
growing demand for care.
In leaner times, "a doctor might not care so much
about reimbursement so long as somebody is in the
chair," said Hales. But today, "We really rely on the
good naturedness of our doctors," he said.
"Now it’s happening." Convincing states to pour
more money into Medicaid has gotten tougher.
As Congress looks to reduce the federal deficit
and wring savings from entitlement programs like
Medicaid, more of the funding burden has fallen to
states.
Despite the penny-pinching climate, Utah lawmakers
boosted Medicaid’s reimbursement rates for doctors by
2.5 percent last year. If the state realizes savings
through a preferred drug list, doctors could get
another 2.5 to 6 percent raise in January.
Hales couldn’t speak to the likelihood of another
hike.
There is no "fair market" benchmark, because costs
vary so much, said Hales. "One dentist’s office might
run really lean, while another might think it
necessary to have TV’s in the ceiling. You could look
at costs for 20 different offices and get 20 different
answers."
But advocates warn the "access problem" for
Medicaid patients is getting worse.
"We’ve been telling people for years this will
happen, and now it’s happening," said Mark
Fotheringham, spokesman for the Utah Medical
Association.
Fotheringham said doctors aren’t shunning their
Medicaid clients, but refusing to take new ones.
"Someone new to the program or the state will have
to make a lot of phone calls before they’re going to
find somebody. And it will probably be a young doctor,
someone who will is building a practice," said
Fotheringham.
The specialist is not in. Specialists are in even
shorter supply.
In 2007, eight specialty groups had zero Medicaid
billings: abdominal surgeon, cardiovascular surgeon,
geriatrician, hand surgeon, head and neck surgeon,
neuroradiologist, pediatric radiologist and
therapeutic radiologist.
That means patients are going to the emergency
room for specialty care, said Fotheringham.
"You hope, at that point, the guy you need is
on-call," he said. "And there are some doctors, such
as orthopedic specialists, who won’t work on-call for
the simple reason they don’t get paid."
Lincoln Nehring, an analyst at the Utah Health
Policy Project, said he has also started to hear of
Medicaid patients being pushed to emergency rooms for
primary care.
Another common practice is for doctors to space
their Medicaid patients, which can mean month-long
waits, said Nehring. "We need to make sure all
Medicaid clients have a medical home."
kstewart@sltrib.com

From: Emil Lazarian | Ararat NewsPress