|
|
Medicaid
Realities,
Tort
Absurdities
Malpractice
insurance and Medicaid reimbursements are pushing
Virginia to the brink of a medical crisis.
Since
1965, Medicaid, a sort of joint venture between the
federal and state governments, has been the largest
provider of medical and health related services to America’s poorest people. That
partnership has consequences for all of us.
The state share of the cost is one of the
major drivers of recent tax increases here in Virginia. But, really,
that is the small end of the impact stick,
especially when considered against the zooming
increases in malpractice insurance costs.
Consider
highlights of a recent letter from T. Carter Melton,
Jr., president of Rockingham
Memorial
Hospital
in Harrisonburg:
“The
central
Shenandoah Valley
is standing on the edge of a medical crisis.
“This
will start as a Medicaid physician access crisis,
but will quickly metastasize into serious second and
third order consequences for our entire medical
delivery system and the broader community.
“It
is being primarily precipitated by the squeeze
between stagnant Medicaid reimbursement rates and
the exploding cost of professional liability
premiums. Local
OB/GYNs and pediatricians have simply been driven to
the point of desperation, and they are saying 'No
More!' Some
will vote with their feet.
“Here
is a current (as of
May 17, 2004
) status report.
-
The
newest member of our
OB
community (who is in his third year here) has
resigned from his practice and is leaving Virginia
for another state.
He has had no claims against him, and his
tail coverage will reportedly be in excess of
$96,000.
-
The
second newest member of our
OB
community has informed his group that he will
leave in the fall if their insurance renewal
premium creates another reduction in income.
Another
OB
in the same group who has been here 10 years may
be on the way out of town soon.
-
A
fourth
OB
is involved in practice dissolution, and will
cease practice in September.
-
A
fifth
OB, with an outstanding record, was just served
with suit papers.
He recently explored the possibility of
joining a larger
OB
practice here in town, but the larger group's
carrier refused to insure him.
-
The
largest
OB
group in town is about to limit the number of
new Medicaid patients it will accept and is
increasing their referral of high-risk patients
(many of whom are Medicaid) out of town.
-
Our
two largest Pediatric practices are closing to
new Medicaid patients.
-
Pilgrim’s
Pride poultry company just announced the closing
of a major plant west of town, and approximately
1,300 workers will be laid off.
We anticipate may of these displaced
workers will lose their health insurance and
flood onto the Medicaid rolls.
-
The
Ethan Allen
furniture plant in Bridgewater
has announced it will close soon. I do not know about the workforce
demographics of this plant, but it would be safe
to assume that some of the 245 laid off workers
will seek medical care through Medicaid.
-
RMH
has between 1800-1900 deliveries per year and
30% are Medicaid. Our local OBs, our pediatricians, and our
hospital not only serve the local Medicaid
population but also that of Page
County, since Page Memorial closed its
OB
service about 10 years ago.
If the worst occurs we will be down to
4.5OBs to deliver 1900 babies—a physical
impossibility.
-
As
this crisis quickly materializes, we anticipate
that the uncovered Medicaid mothers in labor,
and uncovered Medicaid children, will begin to
show up in our Emergency Department (which was
designed for 40,000 visits annually but now
accommodates approximately 60,000).
“The
state must take a proactive, leadership position in
staving off this crisis.
Medicaid reimbursement and liability/tort
reform are beyond the ability of Rockingham Memorial
to solve.”
This
crisis is not confined to any one region of Virginia. Bill
McKelway, writing Wednesday in the Richmond Times
Dispatch, detailed similar anxieties state wide,
pointing out that
OB
units have shut down in the Northern Neck, near
Clifton Forge, in Norton, in Russell
County, and at Buchanan
General
Hospital, in Grundy — all within the past eight months.
The
situation has prompted Jane Woods, Virginia’s secretary of health and human services, to
recommend that Gov. Mark R. Warner seek emergency
authority to increase reimbursements to
obstetricians who treat Medicaid patients, according
to the Times Dispatch.
Indications
from the Governor’s Office were that Warner
“likely” won’t consider recommendations in
Woods’ report until the fall, according to
McKelway’s report.
But
that may not be good enough.
The best indications are that this one
can’t wait.
-- July 12, 2004
|
|
