Doctors React to Medicaid Cuts and Athlete Concussion Bill

Budget amendments from both the House and Senate…would call for between 5 and 8 percent reductions in Medicaid reimbursement to physicians and health care providers.

Dr. Dan Carey, President of the Medical Society of Virginia and a practicing Cardiologist from Lynchburg says these cuts will dramatically change the state of healthcare in Virginia.  

Carey: Unfortunately Medicaid funding in Virginia is 48th out of the 50 states. That’s in Virginia where we have a per capita income that’s sixth in the country, so we’re already at the bear bones.

Currently physicians that provide care to Medicaid patients do so out of personal conviction, not out of any sustainable business model. Currently on average physicians are reimbursed at approximately 68 percent or so of the cost of doing that care. So not only is there no margin, but it’s well under the cost of providing the care. If we were building roads there would be no roads built if vendors for road building were paid 68 cents when it costs a dollar to build a mile of road. We’re not cutting fat here. We’re cutting muscle and bone.  

A survey that the Medical Society of Virginia took among their members showed that current reductions to Medicaid reimbursement will force the majority of doctors in Virginia to stop accepting Medicaid patients altogether.  

Carey: We asked them a simple question. If there was a five percent cut in Medicaid reimbursement, how would you respond in your practice? What would you do if there was a five to ten percent cut? The results of that survey showed that if there was a five percent reduction that 64 percent would stop taking new Medicaid patients or they would be forced to stop seeing the current Medicaid patients they’re seeing.  If it was between five and ten percent, and one of the proposals is 8 percent, then 75 percent of the respondents would be forced to do that.  

Carey notes that this will lead to a flooding of emergency rooms that could also affect the care and cost structure for everyone.  

Carey: These 780,000 beneficiaries of Medicaid in Virginia are going to see care, but they’re just going to see care in a much more inefficient system…emergency departments. Emergency departments are excellent places to receive life saving care when you are critically ill, when you’re injured, when you’re having a heart attack or a stroke, when you’ve had trauma from a bicycle accident, or motor vehicle accident.  They are not an efficient place to get care for sore throats, outpatient urinary tract infections, for sick child visits, for those types of things. They will clog up the works for which that high intensity, high tech environment was designed to take care of the critically ill in an emergency situation. These folks will go into higher cost environments like emergency departments and this will lead to increasing costs that will eventually be borne by all citizens of Virginia, as well as the businesses and others that pay insurance premiums. It’s about everybody going to lead to another round of cost shifting that’s going to affect the efficiency and costliness of healthcare in the entire commonwealth.  

In other legislative news, Democratic Senator Ralph Northam of Norfolk has introduced a bill that would state that once a student athlete has sustained a concussion he or she will be removed from game play for the remainder of the day and should not return to the playing field until cleared by a licensed physician.  

Northam, who works full time as a pediatric neurologist, says concussions can lead to long-term problems and should not be taken lightly.  

Northam: A concussion occurs when there is a sudden jarring of the brain within the skull, that causes mental changes and they can be in the form of dizziness, confusion, incoordination. We’ve known over the last 15 or 20 years that repeated concussions are certainly not good for the brain. We’re seeing more concussions now than we used to. My reasoning for that is that our athletes, are stronger and are faster.  We’re continuing to see concussions and I think an increase in number

We have increasing pressure for these athletes to return to play and sometimes it’s even glorified. ‘Oh, how could this athlete, after having a concussion, be back in the game?’

While Senator Northam’s bill would not impose a criminal or civil penalty for coaches who returned a student to play before getting clearance from a physician, he says it would encourage school administrators to enforce the practice.  

Ralph Northam: Things happen up here in small steps and the main purpose of this legislation is education to establish the guidelines and if we see down the road that there are coaches or parents abusing this then we’ll take another step.  

Senator Northam says that the athletes would be responsible for covering the costs of testing, through their individual insurance policies, to determine if they are fit to return to play. The bill passed the Senate unanimously and is going before the House education committee today.
 
Craig Carper, WCVE News, Capitol Square.