Effect of Medicaid Reform on Broward County Providers

1. Effect of Medicaid Reform on Broward County Providers Arthur E. Palamara, MD Broward County Medical Association

2. Enrollment 105,000 were transitioned 25,000 remain to be �wrapped up� Eligibles dropped from 190,000 to 170,000 (nobody knows what happened to the rest)

3. Outreach Choice counselors handled 90,000 phone calls < 5% handled face-to-face Personal outreach difficult via phone Most recipients didn�t know what they were �buying� Brochure looked like �coupon book� and many threw it away

4. Outreach One nurse for Broward County Choice Counselors not well-trained � didn�t have a great deal of knowledge Developmentally disabled mistakenly put into plan � when taken out, they were placed in unaffordable �Share of Cost� program

5. Mental Health � a mess Counselors didn�t have adequate knowledge of medications Population is especially vulnerable � unable to make good �life decisions� Psychotropic medications not formulary Given wrong advice

6. �Choice Window� Enrollees have 90 days to change to change carriers 5% changed in December 6% changed January Coming to an end Result???

7. Carriers North Broward PSN has only 7,000 enrollees (mostly high-risk) HealthNet/HealthEast� 30,000 lives Pediatric Associates � 10,000 lives Remainder scattered in the other 11 plans Too many plans

8. Pediatric Special-Needs Providers: �a mess� Takes care of 600 �Special Needs� Title 21 patients) who are �medically involved� Huge obstacles to obtain care Unable to access care in Dade County Authorization needed for everything Each intervention requires �authorization� Impossibly burdensome VERY difficult for kids with HIV

9. Pediatrics Physiotherapy Not receiving the visits that they need Therapy being denied Small providers unable to comply with massive bureaucratic requirements of carriers

10. Ob-Gyn Providers 1 Accepts Medicaid because of �social responsibility� 15% of Practice Reimbursement impossibly low C-Section - $832 Tubal ligation - $23 When done together cannot submit electronically Reimbursements LOWER than before reform

11. Ob-Gyn Providers 2 In last 3 months, flooded with patients searching for obstetricians Some with HIV, and 20 weeks pregnant Specialists no longer available Signed up with Vista, United, Humana, Staywell � each with own panel and regulations

12. Ob-Gyn 3 Unable to schedule ultrasounds with Memorial Regional Multiple patients did not know what plan they were in � were switched 2 weeks before delivery!!! (Medicaid office stated that they should not have been switched)

13. Ob-Gyn 4 Doctors not getting paid for work Patients not receiving care they need Huge Bureaucratic obstacles MUCH more difficult than before

14. Carrier�s Profitability - 2005 Staywell return on revenue � 26% HealthEast return on revenue � 16% Average expense 81.6% pmpm Profit: 18.6%

15. Physicians Number of physicians in Fla. - 35,000 Number of physicians in Medicaid - 33,179 Number of physicians paid more than $10,000 - 13,100 Number of participating doctors will likely decrease because of frustration

16. Conclusion 1 Not working for providers 14 plans are TOO MANY Patients unable to obtain care are going to the Emergency Room (increasing hospital- taxpayer�s costs) Increased paperwork BARRIER to care One unified system has been replaced with 14

17. Conclusion 2 Broward had 70% of patients already in Medicaid HMOs Duval has 30% of patients in Medicaid HMOs (transition more difficult?) Broward has 14 carriers Duval has �only� 5 14 PLANS UNMANAGEABLE

18. Conclusions 3 Physician Reimbursement too low � carriers making all the money Medicaid Reform not adding value Doctors will not see new patients Increased burden (costs) on Hospitals Too early to claim success