NY's Medicaid Payments to Doctors Nearly Last in Nation
ALBANY, N.Y. (AP) _ Dr. Nancy Gadziala believes everyone, no matter how poor, has a right to health care. And her conviction is costing her.
A new report shows that while New York's Medicaid program is one of the richest for patients in the country, it's second to last when it comes to the amount it pays doctors and other health care providers.
That can be bad news not just for doctors who treat Medicaid patients, but for patients who may find limited Medicaid-paid care, especially in rural areas.
Since some Medicaid patients aren't able to see the same doctor with each visit, it can also be more likely that dangerous symptoms and health changes won't be spotted.
``There has to be a balance,'' Gadziala said. ``No one can provide an office and provide medical care and lose money constantly they just can't stay in practice.''
While New York has generously spent more per Medicaid enrollee $7,500, than nearly every other state, it performed poorly when evaluated for payments to health care providers, according to the report by Public Citizen, a nonprofit interest group.
For example, at Gadziala's practice, Blue Cross Blue Shield reimburses $2,979 for a PET scan which is similar to an X-ray while Medicaid pays only $1,970. For a CT scan of the sinus, Blue Cross Blue Shield reimburses $275, while Medicaid pays only $120. A CT scan is a method of making multiple X-ray images and using a computer to construct cross sectional views from those images.
``It's a huge problem, because what happens is private physicians can't afford to see Medicaid patients,'' said Maxine Golub, senior vice president of the Planning and Development Institute for Urban Family Health.
The Spitzer administration on Thursday proposed an increase in the Medicaid reimbursements paid to doctors in the 2008-2009 budget. The goal is to make it more financially attractive for more doctors to accept Medicaid patients. The proposal is going to the Legislature.
Jeffrey Hammond, a spokesman for the Department of Health, said Medicaid patients in certain rural areas, particularly smaller communities upstate, were more likely than others to have difficulty accessing care.
The study found only New Jersey ranked lower than New York for reimbursing health care providers for the cost of Medicaid. In particular, dental care, mental health care and specialists are the most difficult to access.
Gadziala is a partner with The Borg and Ide Group, a radiology and diagnostic imaging private practice in Rochester. She said her group accepts Medicaid, even though the difference in compensation between that and private insurance can be dramatic.
Her practice sets no limits on the amount of Medicaid or Medicare patients they accept, but the cost is making some doctors think twice. Some may decide to relocate to areas where more people have private insurance, or even leave the field.
``It's one of the pressures people feel about seeking early retirement,'' Gadziala said.
Nonetheless, health care ``should be a basic right for everyone,'' she said.
New York scored big points in the Medicaid report for the quality of care, scope of services and eligibility. Overall, the Public Citizen report ranked the state eighth in the nation. Massachusetts topped the list, followed by Nebraska, Vermont, Alaska, Wisconsin, Rhode Island and Minnesota.
``The quality has actually improved and I think the coverage has improved,'' said Anne Erickson, executive director of the Empire Justice Center, a statewide, multi-issue nonprofit law firm helping poor and low income families. ``It's just really doing what I think Medicaid should be doing.''
Mississippi ranked the lowest overall for Medicaid programs, followed by Idaho, Texas, Oklahoma, South Dakota, Indiana, South Carolina and Colorado.
New York spends heavily on Medicaid _ $40.7 billion is projected for fiscal year 2007-2008, about 34 percent of the total state budget, according to the Department of Health. State law sets the reimbursement rates.
Medicaid spending in New York increased by 42 percent between
2000 and 2005, and enrollment including the family health plus program grew by 54 percent during the same period, Hammond said. New York state Medicaid serves 4.1 million people.
The study was limited because it only looked at payments made under fee-for-service systems, Erickson said. Those plans pay per visit to the hospital, unlike managed care systems that pay a monthly fee.
Nonetheless, low reimbursement is an important issue in New York that should be evaluated, she said.
New York Medicaid is expensive because of expansive eligibility and because the state has a robust benefit package, said Denise Soffel, coordinator for Medicaid Matters New York.
``There are services covered here in New York that are not covered in other places,'' she said. ``I would argue that that's a strength of our program, but it does make it more expensive.''
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