Provider Rebellion in the Golden State

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OBC-thumb3California has long been held up as one of the most prominent states in the health-care reform movement. It was, after all, an early adopter of reform and is home to outspoken reform advocate Kaiser Permanente.

However, physicians within the Golden State aren’t necessarily as pro-reform as the rest of the providers in the state.

Richard Pollock of the Washington Examiner  reports, “An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate,” this according to Dr. Richard Thorp, president of the California Medical Association, which is the state’s largest medical association.

Incidentally, Dr. Thorp is a primary-care physician who has 38 years of small-town practice experience; out of the 104,000 physicians in California, Dr. Thorp and CMA represent 38,000.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” he said.

Not surprisingly, reimbursements are the driving force behind the physicians’ rebellion. According to Pollock, “California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.”

Pollock adds, “In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal’s reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose, and throat doctor. In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160.”

Dr. Thorp charges: “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that.”

If any thoughts of shady dealings on the part of Medi-Cal, California’s Medicaid plan, had ever crossed the state’s physicians’ minds, these thoughts were only confirmed when the reimbursement rates weren’t disclosed until September of this year; the federal government’s website woes with are also reflected in the fact that Covered California has inaccurately included physicians on its website as participants in the program, when these physicians haven’t even agreed to be included.

In other words, Lisa Folberg, vice president of CMA’s medical and regulatory policy division, said, these physicians “were included basically without their permission.”

Donald Waters, who represents 3,100 East Bay area physicians as executive director of the Alameda-Contra Costa Medical Association, said, “They may be listed as actually participating, but not of their own volition. This is a dirty little secret that is not really talked about as they promote Covered California.”

As a result, he charges that Covered California is actually a “shell game.”

So just how many of California’s licensed physicians are boycotting the state exchange?

70 percent or an estimated 72,800 physicians.

Covered California is saying that it “expects as many as 85 percent of the state’s doctors will join the new exchange,” but Dr. Mazer wants to know the origin of this estimate. “…[T]hey’ve shown no numbers,” he contests.

On top of that, the state, already suffering from a physician shortage, might experience a wave of retiring physicians, Mazer said. “I just turned 55, and a lot of us are kind of going, ‘Maybe there’s something else we can do in the last 10 years,’ because this is just getting too onerous to keep on going.”

Alex Briscoe, health director for Alameda County Health Care Services Agency, isn’t surprised that physicians aren’t complying. “It rings true. I’ve been kind of wondering in my head, ‘How are they offering such low premiums?’”

What are some of the issues that physicians have with reform in your state? How are you, as healthcare executives, trying to appease those concerns and work with them?

-by Pete Fernbaugh

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