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BY J.M. BRODIE
Michael Lewis, M.D., of Hudson, N.C., is a small-town family physician who has run his solo practice in the same place since 1972. "I've been here forever," he said, though he's finding that staying in practice may ultimately mean jettisoning part of his patient base -- his Medicaid patients.
Lewis has about 60 Medicaid patients and has decided not to take new ones because of diminished Medicaid payments. The reimbursement keeps falling further behind rising practice costs. "The only Medicaid patients I'm taking are those who are already in the practice or their family members," he said.
Physicians fear that deep cuts in Medicaid could result in clinic doors shutting completely, patients having greater difficulty accessing physicians and eligibility standards rising. The result could be an increase in emergency room visits as Medicaid patients are priced out of primary care. Emergency room costs are much higher, and cities and counties would have to pick up the tab.
Patients lose coverage as their Medicaid eligibility -- up for review every few months -- comes and goes. "Just today, a fellow came in and said, 'I don't understand why they've taken me off,'" Lewis said. The patient was on Medicaid all of last year, and then suddenly Lewis got a letter saying the patient wasn't on Medicaid anymore.
"What will happen if you carry out all of the Medicare and Medicaid coverage (cuts), if you carry out all the managed care to its conclusion -- all of that trimming? There won't be any small-town doctors," predicted Lewis. "In a practice like mine, I can't spread my overhead among six people. It's just me. I'm only one person."
Yvette Rooks, M.D., assistant professor at the University of Maryland School of Medicine's family medicine department in Baltimore's inner city, agreed many physicians may stop seeing Medicaid patients. She noted physicians may get only minimal Medicaid payment for a full physical. "Doctors in private offices will stop accepting Medicaid patients -- especially those doctors who have been out there awhile and have tasted the fruits of the past," she said.
"The global picture is that there needs to be more money spent on health care," Rooks said. "There are so many things on the table, but the only way to fix this is if there is more money to fund services. There is not enough money for primary health care."
In Miami, Bernd Wollschlaeger, M.D., supports any attempts to overhaul an increasingly unwieldy system while expressing doubts that any relief would be in time to reverse his decision to stop taking Medicaid patients.
"I got a renewal letter in the mail wanting me to renew my Medicaid, and I just dropped it," said Wollschlaeger, a solo practitioner. "When you look at the efforts you put in and the reimbursement that you take out, you have a negative balance. I made the decision because it was just unbearable."
Wollschlaeger said his sentiment is shared by a number of FPs who entered the profession to treat patients in need, only to find themselves struggling to stay afloat in a sea of rising medical costs.
"I took (Medicaid patients) because I felt very strongly that physicians should provide Medicaid services to an indigent population," Wollschlaeger said. "Now I am making a very simple survival decision. I just cannot do indigent care anymore."
For now, many physicians are watching and waiting, hoping for relief.
"They (government officials) are coming very close to cutting small practices out of Medicaid," said Lewis. "A few years back, they said, 'We'll cut the rates and the doctors will just compensate by seeing more people.' I can't see more people. I'm full and over full every day."
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
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Copyright © 2003 by
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