Doctors could get Medicaid incentive

LORRINE THOMPSON, THE OLYMPIAN

Originally published February 8, 2002

LACEY -- Two dozen physicians, medical office staff members and other health workers listened Thursday as state officials pitched a plan to have them accept more Medicaid patients.

Many left the recruitment meetings with a wait-and-see attitude.

The state Medical Assistance Administration is trying to persuade more Thurston County physicians to accept Medicaid patients.

Medicaid is the government insurance program for low-income children and adults.

Thurston County is one of a handful of counties across the state with a care crisis -- thousands of county residents cannot find physicians who will accept new Medicaid patients.

The state has identified about 6,000 Thurston County residents -- mostly children and their parents -- who qualify for a Medicaid program called Healthy Options but cannot use it, said Robin McIlvaine, program manager with the Medical Assistance Administration.

South Sound physicians began closing their doors to Medicaid patients about a year ago, citing low payments, extensive paperwork and what they feel is an offensive new state auditing program.

More money, less paperwork

In hopes of opening some physician doors in hard-hit counties, the administration created a new program that pays slightly more, reduces paperwork and allows physicians to be case managers for Medicaid patients.

Midwives and nurse practitioners can also be primary-care providers in the program, McIlvaine said.

"I think this can make a difference if it's done well, if our concerns are taken back and some of the kinks are worked out," said Dr. Stephen Albrecht, who attended one of three presentations on the program.

Albrecht, a family practice physician with Olympia Family Medicine, said the program as described would be better than the Medicaid insurance now offered in Thurston County.

Two companies -- Molina and the Community Health Plan of Washington -- contract with the state to provide Medicaid coverage in the county.

The new program, called the Washington State Health Network, is operated by the state rather than an insurance company.

It will pay physicians $5 per patient per month for case management and increases fees for caring for children. It also has fewer paperwork requirements because physicians will need fewer referral authorizations, among other benefits.

"I think it's very clear that it's a better deal than we're getting now," Albrecht said. "It contributes toward adequate funding and practice viability."

Olympia Family Medicine closed its doors to new Medicaid patients last year.

Richard Charbonneau, director of contracting for Capital Medical Center, agrees that the program could be beneficial.

"It's a much better deal than what's being offered by CHPW and Molina," Charbonneau said. "You lose less money."

Charbonneau attended a session so he can take information to primary-care physicians connected to Capital Medical Center.

Waiting for details

Kari Karch-Shields, office manager for Tumwater Family Practice, said her office might be interested, but she wants to see the program's final details.

Pam Hyre, office manager for Pediatric Associates, said she also wants to see final details of the program and get a feel for how it would work.

"Everything is simplified on paper," she said.

Both Tumwater Family Medicine and Pediatric Associates had to close their practices to new Medicaid patients.

Despite some enthusiasm, those at the meetings found some major stumbling blocks with the proposed program:

- Physicians who already contract with Molina or Community Health plan of Washington might not qualify for joining the new program.

"This comes out of an intent not to compete," McIlvaine told health workers.

However, that would cut out all physician offices that currently care for some Medicaid patients but can't afford to take more, Albrecht and others said.

"We've been one of the only practices in town to take new (Medicaid) patients, and now you're telling me that we can't be involved in this?" Hyre said during the meeting. "That is a highly unfair situation."

It could be an incentive for some practices to discontinue accepting the other Medicaid plans so they can join the new network, Albrecht pointed out.

Under that rule, his practice could not join the new program -- nor could Tumwater Family Practice, Pediatric Associates and many physician offices.

"That's not going to expand access (to physicians), if that's your goal," said Sherri McDonald, deputy director of the Thurston County Public Health and Social Services Department, who attended one of the sessions.

- Lack of specialists who will take Medicaid referrals from family practitioners.

"It's a huge problem for primary-care providers," Karch-Shields said.

So few specialists accept Medicaid insurance that primary-care physicians can spend hours of staff time searching for a specialist for their patient.

"If you can't find them care, you can't take care of your patients," Karch-Shields said. If the new program does not include better access to specialists, "it's not going to fly," she said.

- Billing concerns were also expressed.

Charbonneau asked if the program can include a guarantee that there won't be any "retrodenials of payment" after care has been approved.

"That's a huge problem for us," he said.

Participants also asked numerous questions about requirements for care authorizations, penalties for patients seeking care in emergency rooms, better communication on Medicaid eligibility and more.

Medical Assistance Administration officials said they're willing to bring concerns and comments back to administrators for review.

"I think whatever we can do to help providers be willing to sign up, we're willing to look at," said Alison Robbins, a contract manager with the administration.

"The bottom line here, as you know, is that there are people who are out there on their own trying to find health care providers," McIlvaine said. "That's pretty difficult. These are people who end up in emergency rooms. ... Our goal is that 100 percent of these folks end up in a plan."

Lorrine Thompson covers Thurston County and health for The Olympian. She can be reached at 360-754-5431.

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