Locally, doctors fret over Medicaid not expanding in Florida

Published: Saturday, March 16, 2013 at 6:35 p.m.
Last Modified: Saturday, March 16, 2013 at 6:35 p.m.

No doctor would ever want to turn away a cancer patient. And yet, when the Florida Senate Select Committee on the Affordable Care Act rejected Medicaid expansion last Monday, it essentially killed the measure that Gov. Rick Scott had endorsed — which has some physicians worried.

“I’m particularly worried about a lot of our indigent patients, that we’re just not going to be able to provide care and will have more people falling through the cracks,” said Dr. Thomas George, an oncologist at Shands at the University of Florida.

Already, many of George’s patients come from rural areas, where health care is spotty, and by the time they seek treatment at Shands, their disease is both advanced and expensive to treat.

“We’re all they’ve got,” said George, who also chairs the Florida Cancer Control and Research and Advisory Council, which advises the Legislature on cancer care and research.

Shands at UF says currently about 8 percent of the patients it treats each year are uninsured, costing about $80 million annually, and the government reimburses $14 million of that — monies lost under the Affordable Care Act that would have been directed to Medicaid expansion had it been approved. Now most of the $14 million will be lost, said Dr. David Guzick, president of the UF&Shands Health System and senior vice president for health affairs.

Plus, the implementation in July of a Diagnosis Related Group (DRG) Medicaid reimbursement plan — which reimburses hospitals based on procedures instead of according to a daily per diem — is also predicted to decrease Medicaid reimbursements for safety net hospitals like Shands, according to a recent analysis by the Florida Agency for Healthcare Administration.

Despite the potentially doom-and-gloom financial message of these cuts, Guzick is confident the institution will continue to care for uninsured patients.

“We’re not going to turn our back on any of them,” Guzick said. “We provide uncompensated care, and will continue to provide uncompensated care.”

And although Monday’s news may have sounded a death knell for advocates of Medicaid expansion, the committee that rejected the expansion is exploring alternatives that propose using the federal Medicaid dollars for state or private plans.

“When the dust settles, if we get back to zero, we’ll be very happy,” Guzick said, adding, “It’s not only a financial issue here. Medically, it’s just a much better situation for these patients to have access to care early enough. If we end up financially in the same place, but get to provide what we think is good care, everyone wins.”

Guzick added that Shands at Jacksonville faces a potentially much more dire situation because it has a larger portion of indigent patients. Gainesville has a more diverse patient population as a statewide referral center, he said.

The politics of Medicaid

While Shands’ own mission of providing good medical care to those in need is politically “agnostic,” Guzick continued, “sometimes the politics gets in the way.”

“I do think the governor and both the House and Senate want to get to the same answer. Each of them in their own way has voiced support for the idea of trying to take care of this population.”

For state Rep. Keith Perry, a Republican representing Alachua, Dixie and Gilchrist counties, the solution is not expanding Medicaid but reforming the system. Using dental care under Medicaid as an example of waste, Perry noted that 13 percent of the population in Alachua County is entitled to comprehensive dental care under Medicaid.

“The question is what do we get for our money?” Perry said. “There is no dentist (in Alachua County) that takes any adults on Medicaid.” At least none in private practice. The ACORN Clinic in Brooker, a nonprofit providing care to low-income families, takes patients of all ages, and Shands sees patients for certain procedures, Perry continued. But for the most part, the portion of taxpayers’ money supporting Medicaid dental care is lost, he said.

Furthermore, expanding Medicaid would bring more, not fewer, patients to the emergency room, because most specialists don’t take Medicaid anyway, so more people with it will only end up at the hospital, Perry said.

Guzick argues that offering Medicaid to more people — specifically the 1 million Floridians to whom expansion would benefit — would enhance preventative care, so people wouldn’t have to end up in the ER.

As an oncologist, George’s clinical idea is having more resources to treat more patients. He added, “The flip side is that there’s not an unlimited source for health care, and as those patients come in, we’re most concerned there’s going to be rationing for everyone. And then everyone suffers — not just Medicaid patients.”

Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.

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