Texas doctors are threatening to stop accepting Medicaid in response to the 1 percent cutback in provider fees that began September 1, and their ongoing frustrations with the Medicaid reimbursement system.
Dr. Arthur Garson Jr., senior vice president for health policy and health systems at the University of Texas Health Science Center in Houston, says he is concerned about the ability of Texas physicians to meet the demands of Medicaid patients. Texas has more than 3.3 million people currently covered by Medicaid, and the state Health and Human Services Commission estimates President Obama’s health care law could add 1.5 million Texans to the Medicaid rolls by 2015.
“There is already a severe physician shortage in Texas, and it could get worse if more doctors don’t accept Medicaid,” Garson said.
Garson notes roughly 15,000 of the state’s 48,700 practicing physicians currently accept Medicaid patients, but many of them are not seeing new patients.
Medical Students Concerned
Garson says medical school students realize year Medicaid reimbursements could be cut. He worries there will be little desire to enter a system about to undergo worsening stresses, with public clinics and emergency rooms becoming increasingly overcrowded.
“Students pay attention to these things, and they begin to look up and see if they can make ends meet or not,” Garson said.
Dr. Kenneth Shine, executive vice chancellor for health affairs for the UT system, said health care institutions must create innovative delivery models to provide care for the growing covered population. The key, he says, is reimbursement.
“State and federal policymakers should be encouraged to maintain and improve Medicaid and Medicare reimbursement rates,” Shine said. “Inadequate reimbursement will decrease the willingness of community physicians to see patients covered by the entities. Institutions cannot afford to care for patients below costs.”
Nationwide Problem, Few Solutions
Garson says a worsening physician shortage will mean fewer doctors in rural areas, and that the poor will find fewer doctors to choose from and more delays in treatment.
“There are other things states can do to help. There are other approaches like the Grand-Aides program here in Houston, a program that is under supervision of nurses where trusted members of the community are trained to serve as liaisons between patients and health professionals,” Garson said.
Garson says the shortage of doctors willing to treat Medicaid patients is not limited to Texas but affects other states as well. He says it will be a nationwide problem under Obama’s law.
“We need more doctors and nurses, not payment reductions. We must train as many as we can, and there still won’t be enough for the coming influx,” Garson said.
Tabassum Rahmani ([email protected]) writes from Dublin, California.