Medi-Cal Hurdles > Seeing Specialists
The volume of poor and uninsured patients that need to see specialists has overwhelmed the health care system in Los Angeles causing appointment delays. Dr. Dressner says he is extremely frustrated with the problem. “If I have patients that need a rheumatology consultation, it can take two years for them to get an appointment,” he explains. Some of his patients have to travel over 50 miles to see specialists who will take MediCal because none of the specialists in the immediate area will. Not only are physicians frustrated with the lack of access to care, the patients themselves are frustrated with their treatment. Barbara Appling, a 56-year-old diabetic, was referred to an orthopedist in the Los Angeles area near her home. “I called the office repeatedly for an appointment. It took four months to get one. Then, when I went to the office,
patients. Debra Lupeika, MD, a family physician providing care through the Shasta Community Health Center in Redding, says some of the most difficult issues she faces are getting her sickest patients referrals to specialty providers. The frustration of not being able to refer wears on her – like the time her patient suffered without an appointment. “She had complicated medical problems, and she was homeless,” Dr. Lupeika says. “She had a cancer on her face that had been partly removed, but it came back. We couldn’t get a biopsy. It is really hard to get our patients into specialists due to insurance issues.” Lack of access to specialists also plagues San Diego County. “The challenge that we face is that reimbursement to physicians is the third-lowest in the country. So that limits access to specialty care,” says Patrick Tellez, MD, MPH, a pediatric allergy and immunology specialist and Chief Medical Officer for North County Health Services, which provides I called the office repeatedly for an appointment. health care to a diverse community of IT TOOK FOUR MONTHS to get one. Then, when low-income patients at 13 health centers in North San Diego and Riverside counties. I went to the office, I was there for 40 minutes “Our mission, as a primary medical, dental waiting to be seen – until the office manager told and behavioral health practice attending to over 65,000 patients annually, is to assure me THEY COULD NOT SEE ME. that our patients are able to access and receive needed primary and specialty care I was there for 40 minutes waiting to be seen – until the that meets the high standards that every one of us expects office manager told me they could not see me.” Appling has when we are the patient,” says Dr. Tellez. “However, when both Medi-Cal and Medicare insurance. The office staff the reimbursement for specialty care is so low, specialists member told her the doctor didn’t take either. can only afford to accept a small percentage of patients that “I’m very frustrated that I cannot see a doctor when I truly need and deserve the care.” need to. People have refused to take Medi-Cal since I got “So, while in an average month we as primary care it,” she said. Due to low Medi-Cal reimbursement rates, providers may make about 2,500 or more referrals physicians who see Medi-Cal patients often do so at a to specialty care, due to affordability, wait times and financial loss to their practices. In order to maintain viable constrained access, less than half are able to be seen. As a practices that can continue to serve their communities, result, this has the long-term adverse impact of increasing physicians who take Medi-Cal often need to limit the the cost of care for everyone. Improving access to number of Medi-Cal patients that can be treated in their specialty care has been shown to help prevent preventable practice. complications of chronic disease, which lowers the longBecause they do not have ready access to physicians, term cost of care… it acts like a rising tide that floats all Medi-Cal patients are more likely to postpone needed care boats.” due to long appointment wait times. They are also twice Of California’s 58 counties, Merced County has the as likely to use emergency room visits to access specialty 43rd worst physician-to-patient-ratio, with just 45.4 care (compared to individuals with private insurance or family physicians per 100,000 residents. That’s far less Medicare). than California’s statewide ratio of 77.3 doctors per In areas where the numbers of specialists are low, 100,000 residents. According to the Merced County 2016 physicians are more likely to report difficulty obtaining Community Health Assessment, the entire county is referrals for Medi-Cal patients than for privately insured considered a health-professional shortage area.
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CENTRAL VALLEY PHYSICIANS
Spring 2017