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Medicaid physicians back in same spot after long-awaited raise expires

Dr. Jaquelin Gotlieb examines a new patient, Jada Smith, 5, at her Stone Mountain office

Dr. Jaquelin Gotlieb, shown examining a patient, says that the Medicaid pay bump is a matter of valuing children.

Dr. Michelle Zeanah is getting a big pay cut this month.

It’s not that the Statesboro pediatrician is seeing fewer patients. Just the opposite.

The 12 rural counties surrounding Bulloch County, where Statesboro is located, have no pediatrician. So Zeanah is very much in demand.

Forty percent of her patients have driving distances of 45 minutes or more. A few come from more than 50 miles away.

Dr. Michelle Zeanah

Dr. Michelle Zeanah

Her pay cut involves the Medicaid program. Reimbursements to primary care doctors under Medicaid just went down in Georgia and many other states.

The Affordable Care Act had awarded primary care doctors treating Medicaid patients a two-year pay increase. It was funded entirely with federal money, and pushed their Medicaid pay to the level of Medicare reimbursement.

But that additional Medicaid reimbursement, which went to family physicians, pediatricians and internists, ended Jan. 1. And doctors will be missing it.

“It allowed us to hire more staff so we could serve more patients,’’ Zeanah says. Without it, she adds, “I will have to work 70 hours a week’’ instead of the current 60.

About 70 percent of her patients are covered by Medicaid or PeachCare (the Georgia version of the child health insurance program).

Medicaid, the federal/state program for the poor and disabled, serves more than 1.5 million Georgians. Most are children.

Before the increase, Georgia primary care doctors had gone more than a dozen years since the last Medicaid pay hike.

A few states, including Alabama and Mississippi, have continued giving their primary care doctors the pay hike by using state dollars to fund it.

But Georgia political leaders, on the eve of the 2015 General Assembly, have shown no signs they’ll appropriate money to reinstate the pay hike. The money that would be needed – an estimated $62 million for a year – is not in the Department of Community Health budget being proposed to Gov. Nathan Deal.

Sasha Dlugolenski, a spokeswoman for the governor, said in an email to GHN in September that Deal was aware of the issue. She called the pay hike expiration “one of the early, blatantly obvious examples of Obamacare unloading costs onto the states. This was a short-term Band-Aid to a long-term problem, and now the states are left holding the bag.”

The federal health law required that the raise be paid for two years, 2013 and 2014. The money actually did not arrive till 2014, but when it did, eligible doctors received the pay hike retroactively to Jan. 1, 2013.

Such delays in the payments occurred in many states, including Georgia, that use managed care in their Medicaid programs.

Practices feel the pinch

The end of the federally funded raise means that Medicaid fees in Georgia will now be reduced by 34.8 percent, according to a recent Urban Institute study.

Some pediatricians describe the pay bump as a children’s health issue. They say children on Medicaid generally have greater health and social needs.

“It’s a matter of valuing children as the future of the state,’’ says Dr. Jaquelin Gotlieb, who practices along with her pediatrician husband, Edward Gotlieb.

“I believe primary care doctors feel a significant responsibility to their patients,” adds Jaquelin Gotlieb, who is 68 and has practiced in Stone Mountain for almost four decades. “That’s why we have hung in there.”

If the pay isn’t restored, she says, “This is going to take some of them and push them over the edge.’’

Dr. Eugene Cindea

Dr. Eugene Cindea

Roughly two-thirds of the Gotliebs’ patients are covered by Medicaid or PeachCare, she says.

Dr. Eugene Cindea, a pediatrician at the Longstreet Clinic in Gainesville, says the extra money “allowed us to expand offerings to patients.”

“It felt good for physicians who were seeing a considerable number of Medicaid patients,” he says.

The goal of the pay hike, Cindea notes, was to increase the number of physicians who accept Medicaid patients.

Without the money, he says, it’s more difficult to devote staff to manage the chronic diseases of children. “It decreases the likelihood that we’ll expand in an underserved area,” he adds.

OB/Gyns were not eligible for the two-year federal pay bump that just ended. Pat Cota, of the Georgia Obstetrical and Gynecological Society, says her organization is asking the state to revive the pay increase and expand it to include OB/Gyns.

The majority of children born in Georgia are covered by Medicaid.




An incentive for doctors

In Alabama, physician participation in Medicaid is a concern. The state says about 22 percent of enrolled primary care physicians now receive 90 percent of all claims payments. The other problem is that Alabama has shortages of health professionals in 62 of its 67 counties.

Niko Corley of the Alabama Medical Association says that “for Medicaid to be as efficient as possible, you’ve got to have physicians managing that care.”

The federal pay hike was supposed to increase doctor participation in Medicaid. But Kaiser Health News has reported that most states say they’ve seen no evidence that it did so — mostly because it was a temporary measure.

“The Medicaid pay boost was never meant to be a silver bullet,” Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for low-income Americans, told KHN. Still, he worries about the provider fee cuts. “It won’t sink the ship but . . . I’m concerned it will contribute to access problems.”

Statesboro pediatrician Zeanah notes that many physicians have limited their numbers of Medicaid patients. That’s why her pediatric practice continues to see more patients.

Having the pay hike meant that the practice stopped losing money on delivering vaccines to kids on Medicaid. “We made a tiny profit,’’ Zeanah says.

Not having the pay hike, though, means more hours and less reimbursement. It means Zeanah and her pediatrician partners can’t build an office building to accommodate the growing practice.

Medicaid patients require more work, and are more often late or no-shows due to reasons such as lack of transportation, she says. “We have no social worker available to us. I am the social worker.”

Georgia desperately wants to recruit new physicians, Zeanah notes. “When you don’t have Medicaid payment parity, it makes it hard.”


Top 10 Georgia health stories in 2014

Here’s the GHN list of the top 10 health stories in Georgia this year.

Let us know what we missed — or what we ranked too high or too low.

1. Ebola struck – and Atlanta responded

140px-US_CDC_logo.svgThe disease that frightened the nation drew a major response from health care professionals in Georgia’s capital. Emory University Hospital treated the first Ebola patient ever in America, as well as one of the first two people to become infected in the United States. Meanwhile, the Atlanta-based CDC sent hundreds of workers to fight the epidemic in West Africa. And the agency issued revised recommendations on what type of protective equipment should be worn by health care workers treating Ebola patients.

2. ACA exchange enrolled more than 316,000 Georgians

Despite the early technical catastrophe of the website, thousands of Georgians chose a health plan, while thousands more were found eligible for Medicaid and PeachCare during the enrollment process. More are expected to sign up during the current open enrollment period, though an upcoming U.S. Supreme Court decision has the potential to derail the exchange in Georgia.

3. Uproar over the State Health Benefit Plan

Sarah Lesley and her daughters joined a Capitol rally in February against the design of the state health plan.

Sarah Lesley and her daughters joined a Capitol rally in February against the design of the state health plan.

The year started with a horde of teachers and state employees upset over changes in their health plan. Lack of insurer choice and the new co-insurance system were the main complaints. A state agency reversed course, switching to a co-pay system, and then reshaped the benefit plan that covers more than 650,000 Georgians to add more choice of insurance options.

4. Rural care crisis gripped Georgia

The fact that four rural hospitals had closed in two years, while several more were at the financial brink, grabbed the attention of politicians and industry leaders. They warned that the loss of health care facilities would deepen the spiral of decline in economically troubled areas. But Gov. Nathan Deal’s proposed solution, the downsizing of struggling hospitals, failed to catch on. Many experts fear 2015 will see more closures.

5. Medical marijuana proposal gained steam in Legislature

Rep. Allen Peake speaks with reporters while Dr. James Smith and his wife, Courtney, look on. They are the parents of a child with a seizure disorder.

Rep. Allen Peake speaks with reporters while Dr. James Smith and his wife, Courtney, look on. The Smiths are the parents of a child with a seizure disorder.

The biggest surprise issue in the General Assembly was the whirlwind created by legislation to legalize medical marijuana in Georgia. The bill failed to pass in 2014, but it carries momentum heading into the new year. The prime supporter, Rep. Allen Peake, and parents of children with seizure disorders will again be trying to push the legislation past the finish line.

6. Anti-Obamacare legislation cleared the General Assembly

State lawmakers passed a bill prohibiting Medicaid expansion in Georgia without legislative approval. They also voted to bar Georgia from running its own health insurance exchange. Much of the energy in opposition to the ACA came from Rep. Jason Spencer (R-Woodbine), who pushed hard to unravel Obamacare in the state.

7. Medicaid expansion movement made no breakthrough

Half the states have expanded Medicaid under the ACA, reducing their numbers of uninsured residents – and helping their hospitals financially. But Georgia’s Republican leaders, wary of the ultimate cost of expansion, continue to block it, and voters in November kept the Republicans firmly in control of the state. Advocates of Medicaid expansion, though they gained no political leverage in 2014, still feel they have a strong argument and hope to make headway through persuasion in the coming year.

8. Standoff between Grady and Blue Cross

unnamedContract negotiations between Atlanta’s biggest hospital and Georgia’s heavyweight insurer broke down in November. Grady became “out of network’’ for Blue Cross and Blue Shield of Georgia patients, raising the patients’ out-of-pocket costs. The issue was fairness – as each side saw it. The health system took its case to the public, running strongly worded ads saying it was being paid unfairly by Blue Cross. The insurer maintained it had been fair and would increase reimbursements to Grady with a new contract. By late December, weeks after most observers had expected a deal, there was no end in sight to the impasse.

9. DFCS backlog and staffing issues persisted

The agency that helps protect Georgia’s children continued to be plagued with turnover, staff shortages and increased workloads in 2014. The state’s child welfare system had to do its work in an atmosphere of tougher scrutiny and harsher criticism, particularly after the gruesome deaths of two children in 2013. The resulting fallout helped lead the state to hire more caseworkers, and spurred Gov. Nathan Deal’s creation of a council to review the child welfare system, as well as an order of mandatory overtime for caseworkers to clear a backlog of cases.

10. Alarm raised on well water risks

Water contamination issuesWell water is recognized as a potential danger if levels of arsenic or other contaminants are too high. Public health officials sent alerts in 2013 to elected officials in 10 counties in South Georgia, as well as to UGA Cooperative Extension agents, health care providers, veterinarian facilities and local libraries, urging people to test their wells regularly to ensure that the water was safe to drink. (The tests are easy and inexpensive.) Public Health repeated these warnings in 2014. But consumers complained that many people across South Georgia had not yet gotten the word that their water might be harmful.


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