Wednesday, November 21, 2012

Medicaid and Primary Care

Attached a link to an article written by John Dorschner titled "Florida will pay Medicaid docs at new Obamacare rate" highlighting that Governor Scott's administration finally relented and, starting Jan. 1, Florida will begin paying Medicaid primary care doctors at new, higher rates required by the federal Affordable Care Act, a state spokeswoman said. The law requires that for the next two years Medicaid must pay primary care doctors at higher rates. According to a study by the Kaiser Family Foundation, Florida primary care doctors in 2008 were paid 55 percent of Medicare rates, meaning a $50 payment would be increased to $90 under the new system. That's indeed good news for all of us, primary care doctors and patients alike. In my case I re-enrolled as a Medicaid provider because more and more of my patients qualified for Medicaid and wanted to continue their care with me. Now, I can afford treating them without loosing money. A great victory for common sense!! But we also have to start demonstrating that this investment into preventive care and chronic disease management will save precious healthcare dollars by decreasing hospital admissions and emergency room utilization rates. That requires the implementation of new care delivery systems such as Patient Centered Medical Homes. I am confident that we can achieve these goals. Happy Thanksgiving Yours Bernd

Friday, November 16, 2012

Governor Scott and Common Sense: A Contradiction?

Attached a link to an article titled "Rick Scott Signals Willingness To Negotiate On Health Care Law" reporting that Florida Governor Rick Scott, one of the most outspoken critics of President Obama's health care law, signaled Tuesday that he may be ready to drop his longstanding opposition to the Patient Protection and Affordable Care Act. In an interview with the Associated Press, the Republican said that he is willing to negotiate with the federal government on implementing the new program. "The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida. … If I can get to yes, I want to get to yes." "I don't think anyone involved in trying to improve health care should say 'no, no, no,'" Scott continued. "Let's have a conversation." Sounds good BUT talk is cheap. Governor Scott can show his change of heart by informing the U.S. Department of Health and Human Services by the deadline tomorrow whether he will set up a Florida health insurance exchange, partner with the federal government, or leave the task to U.S. authorities. The clock is ticking Governor!!

Sunday, November 11, 2012

Tallahassee is not Teheran

Tallahassee is not Teheran: We need a real Governor and not a spiritual (mis)leader Attached a link to John Dorschner's excellent front page article in today's Miami Herald titled “Gov. Rick Scott may shift stance on health reform law” reporting that Florida Governor Rick Scott may be open to discuss the (partial) implementation of the Patient Protection and Affordable Care Act (PPACA). The article correctly points out three important milestones which need to be achieved in order to move ahead with the healthcare law implementation: 1) The statutory deadline for submitting Florida’s blueprint for a new health insurance exchange is November 16. Unfortunately, the stubborn refusal of our political leaders in Tallahassee to even consider the creation of a healthcare exchange will force the federal government to step in to set up such an exchange. 2) According to the final PPACA rule Medicaid payments to primary care physicians will be increased to reach Medicare levels. The final rule requires state governments to take further action prior to 2013 to implement this provision. States, including Florida, will receive an estimated $11 billion in new funds over 2013 and 2014 to bolster their Medicaid primary care delivery systems. More than six in 10 (64 percent) family physicians accept new Medicaid patients, and these beneficiaries comprise 15 percent of the average family physician’s patient panel. Governor Scott has refused to accept additional Medicaid funding to increase the pay for primary care physicians. As a result of the increasingly inadequate Medicaid payments nearly two in 10 family physicians have stopped accepting new Medicaid patients. 3) On Jan. 1, 2014, a major expansion of people covered by Medicaid will go into effect. If Governor Scott decides not to expand Medicaid coverage, Florida will lose $27.9 billion in federal funds over 10 years. That breaks down to a $4.5 billion loss for Miami-Dade during that time, and a $2.3 billion loss for Broward. Under the law, Washington will pay all Medicaid expansion costs for the first three years, but then the states would have to pay up to 10 percent of the costs in following years which will amount to approximately $1.7 billion over 10 years in Florida. The expansion could provide coverage to an additional million-plus Floridians. Florida's political leadership has so far stubbornly refused to participate in or prepare for ANY of the above mentioned changes. Subsequently, billions of federal funds will be appropriated to those states who do participate. Our political leaders should be aware about the adverse consequences of their stubborn refusal to implement this federal law. Florida having the third-highest rate of uninsured residents in the country stands to benefit more than most states from the Medicaid expansion intended to increase preventive care and to reduce unnecessary emergency room visits. Health experts warn that not expanding Medicaid could cost Floridians, because many of the state's 3.8 million uninsured residents will continue to receive care they can't pay for in hospital ERs. Those costs ultimately are passed down in the form of higher insurance premiums for everyone else and will further strain the existing Medicaid budget. Often hospitals end up absorbing large amounts of uncompensated, or "charity" care, which experts say affects Floridians in several ways. To recoup those costs, hospitals either reduce services or charge higher rates to insurance companies, or both. Those costs are often passed down to businesses as a “hidden tax” adding to the insurance costs for their employees. Furthermore, health providers have long complained that Medicaid reimbursements are so low they don't cover the costs of care. And because of low reimbursements, fewer physicians in the state actually accept new Medicaid patients. The increase in Medicaid reimbursement by almost 7 % for primary care physicians will allow family doctors, pediatricians and internists to accept new Medicaid patients and to offer urgently needed preventive medical care. I am convinced that Governor Scott knows all of the above mentioned facts but he still refuses to act. In my opinion this represents an egregious case of political malpractice ! Why is this being overlooked? Maybe, Republican leaders consider Tallahassee as their spiritual Mecca and are sacrificing the health of our citizens on the altar of ideological correctness and purity. But Tallahassee is not Teheran and we definitely do not need a supreme leader to decide our personal fate. Governor Scott should recognize that he is not the Governor of the Republicans of Florida but the Governor of the State of Florida. If he is incapable or unwilling to fulfill his constitutional obligation to implement a federal law then he should step down! Its time to man up Governor or to hit the road! Bernd Wollschlaeger,MD,FAAFP,FASAM