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Primary Care Docs Don’t Spend Less Time With Safety Net Patients, Study Says
Primary Care Docs Don’t Spend Less Time With Safety Net Patients, Study Says
By John Reichard, CQ HealthBeat Editor
Primary care physicians spend as much time with and provide comparable tests and services to their uninsured and Medicaid patients or those they treat at community health centers as they do with patients who have private insurance coverage, a new study says.
That finding was based on an examination of 31,000 visits to primary care physicians from 2006 through 2010. The study by George Washington University
“Although safety-net patients may encounter barriers to obtaining primary care, it appears that when they do visit a physician, they are treated comparably to other patients,” said the study led by Brian K. Bruen, a health policy researcher at GW. The findings were published in the September issue of the policy journal Health Affairs.
The researchers said they did the study to test the accuracy of criticism that the treatment of safety net patients is substandard. They did not examine specialty care or hospital care.
“Critics of the Affordable Care Act’s expansion of Medicaid argue that the federal program provides poor care and that patients would receive better or less costly care with private insurance,” they noted.
The study did not analyze differences between safety net patients and commercially insured patients in how easily they were able to get in to see a doctor. In many instances, doctors say there is a limit to the number of Medicaid or uninsured patients they can see, insisting that without enough patients with private coverage and its higher payment rates they can’t keep their practices afloat. For example, the California Medical Association, which represents physicians, has said that low Medicaid payment rates in the state will keep poor people from getting access to doctors.
“It is important to remember that a patient must be able to obtain care in the first place,” said the study. “The Affordable Care Act expands funding for community health centers and raises payment rates in Medicaid for primary care physicians, which should expand Medicaid patients’ access to primary care providers.”
The researchers said they focused on the length of a medical visit because “it is an important indicator of quality of care.” They also checked for differences in diagnostic and health counseling services, and in treatment services, concluding that any differences were “modest.”
On the diagnostic and treatment side, for example, they said they took into account 39 different services that a doctor could offer a patients, such as checking blood pressure, screening for depression, testing cholesterol, and providing care for a wound.
The average primary care visit lasted 18 and a half minutes, they found. On average each visit included providing or ordering four procedures or diagnostic tests, one health education or counseling service, and two medications or immunizations. Among the study’s limits they cited the fact that doctors reported the length of visits, which was not subject to independent verification.
State workers, retirees object to single plan, higher-out-of pocket costs for state health insurance
State workers, retirees object to single plan, higher-out-of pocket costs for state health insurance
September 9, 2013
By Walter C. Jones The Florida Times Union
The half-million state workers, retirees, teachers and school workers will also see their coverage revised when 2014 begins.
State officials boast that premiums are being held in place, but some critics complain that they’ll still be paying more out of their pockets because of limits on coverage.
“The main message that we want to convey and we’re trying to convey is for most members the premiums will stay the same or go down,” said Pam Keene, spokeswoman for the Department of Community Health that oversees the State Health Benefit Plan.
One key way to hold premiums down, she said Monday, was the department’s decision to contract with just one administrator for employees living outside of metro Atlanta
Traditionally, employees had a choice between two insurance companies. Although they both offered the same plans, each had its own network of doctors and hospitals.
Some observers say the competition between the companies provided them reason to maintain peak service.
“The competition came in during the bid process,”Keene
She estimates the resulting savings will be more than $200 million next year.
However, the department still plans to have two insurance companies administering claims in theAtlanta
Rep. Ben Harbin, R-Evans, said he’s gotten complaint calls already from teachers and state workers about the lack of choice.
“People are going to have to change doctors, possibly hospitals, because people don’t have a choice, and it’s a decision made by some bureaucrat in Atlanta
The number of administrators is less of a concern to the Georgia State Retirees Association than the reduced coverage, according to its treasurer, B.J. Bennett.
“I take real issue with the statement that the premiums are not going to go up for employees,” she said.
Comparing the current plans to next year’s alterations to reflect federal health-reform requirements is complicated, Bennett admits. But her analysis shows that since 2011, the maximum out-of-pocket expense for deductibles and co-insurance has doubled in some cases. And what employees and retirees pay for prescription medicines no longer count toward their maximum.
Bennett sees only one solution, convincing elected officials to pitch in more taxpayer money to subsidize the employee premiums rather than education, jobs, tax breaks or other policy options.
“The governor and the legislature would have to have some heat on them,” she said. “As long as there’s not a lot of heat, they’re going to put the money where they want to put it.”
Medicaid, PeachCare ranks growing
Medicaid, PeachCare ranks growing
By Craig Schneider and Ernie Suggs Atlanta Journal Constitution 9/8/13
More than three years after the Great Recession officially ended, a record 1.8 million Georgians are enrolled in Medicaid and the state’s child health insurance program, the latest state figures show. That’s nearly one in five residents.
The two programs, funded by a combination of federal and state dollars, are paying out more than $8.6 billion a year, according to recent figures for fiscal 2013. About $2.6 billion is state money.
Looking ahead, the state expects the rolls to swell still further, in part because an estimated 65,000 people will enroll over the next two years in response to the Affordable Care Act.
That alone could cost the state an additional $55 million over the two years, according to projections by the state Department of Community Health.
Although Georgia
“Georgia has seen a less-than-stellar recovery,” said Pat Willis, executive director of the Voices for Georgia
Children. “We continue to see a rise in poverty.”
For Cheryl Plowden and her family, the recession never ended.
In 2011, her husband, who had been self-employed for 17 years, died of cancer. Plowden’s children qualified for PeachCare, for which she pays $52 a month.
“We are not middle class anymore,” said Plowden, 49, of Fayetteville
Since June 2009, when the nation’s economy began to grow again, Georgia
The programs are expected to gain another 80,000 people next year.
The bulk of Medicaid spending, 58 percent, goes to provide care for people who are blind, disabled or who require nursing home care and have exhausted their own resources. Adult Georgians who are poor but able-bodied do not qualify for Medicaid.
Medicaid also serves pregnant women and children whose families are poor. Peach-Care provides health insurance for children of the working poor, who have somewhat higher incomes.
The federal government pays about 66 percent of the Medicaid bill and 76 percent of Peach-Care. Georgia spends less on its average recipient than any state but California
The future of Medicaid is a sore subject between Georgia
In Georgia Georgia Georgia
A joint committee of members of the state House and Senate recently began analyzing how the state can best meet the health needs of those who lack private insurance without overburdening taxpayers.
Deciphering enrollment trends in Medicaid and Peach-Care can be complicated. For instance, although the recession began in December, 2007, both programs saw decreases in enrollment during 2008. Some advocates attribute that to DCH implementing stricter requirements on proof of identity, income and citizenship.
As for why the rolls continue to grow even as the economy improves, state officials and experts point to several factors. The most obvious is that the state’s population is growing — although not nearly as fast as the number of people enrolled in the two programs.
Beyond that, DCH spokeswoman Pamela Keene cited the lingering effects of the recession, the aging of the population, an increasing awareness of the programs, and a policy change that allowed thousands of children of state workers to shift from the state health insurance plan to PeachCare.
Timothy Sweeney, director of health policy for the Georgia Budget and Policy Institute, pointed to a national trend of fewer employers offering health insurance. DCH’s growing caseload “indicates private health insurance is not available to a lot of people in this state.”
Tricia Brooks, a senior fellow with the Georgetown University Center for Children and Families, said that in the past Georgia
“The high growth has occurred in those states that traditionally have not done as good a job in enrolling people,” Brooks said, citing Florida and Texas
Whatever the reason, studies have found lower rates of enrollment in Georgia
Only three states have more children who qualify for government-paid health care but who remain uninsured, according to the Urban Institute. But, post-recession, Georgia did see a dramatic increase in child enrollment, the Georgetown
It wasn’t just that more families sought help because the recession threw them into crisis, Brooks suggested. It’s that they passed the word.
“More and more people are finding out about programs they qualify for,” she said.
For Plowden, PeachCare makes the difference between scraping by and insurmountable debt.
With it, she pays $20 a month — instead of more than $1,000 — for the eight medicines that her 11-year-old daughter, Jasmine, takes daily. Visits every two weeks to two doctors cost $6 instead of hundreds.
“Without it, I wouldn’t be able to buy her medications,” she says. “We would probably be homeless.”
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