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Commentary: What to do about health care? Increase Medicaid reimbursements

This article first appeared in the St. Louis Beacon, Oct. 29, 2009 - Health-care reform has engendered a broad public debate around a variety of related issues. Except for one that has been largely ignored. The most vulnerable members of our society, our children, are under-served by the health-care industry and the health-care public safety net due to a limited availability of pediatric physicians to care for their primary and special needs.

What's the problem? The reimbursements paid by Medicaid do not cover the cost of providing care, so many community physicians either limit or do not serve Medicaid patients. According to the Missouri Department of Social Services, of the 12,800 physicians enrolled in Missouri Medicaid, only 61 percent are active providers.

Access to pediatric specialty care is even more challenging. In Missouri, when medical students in pediatrics make their career decisions in the course of their residency training, they are choosing general over specialty certification by a margin of two to one. The result? One example is an average of 1.2 endocrinologists per 100,000 children. In the face of rising diabetes, obesity and associated health problems in our youth, this is not very encouraging. It's the same situation in the vast majority of the other 30-plus pediatric specialties.

If a child enrolled in the Medicaid program manages to gain access to a primary care physician, he or she is unlikely to maintain regular visits simply because there aren't enough physicians to serve this basic need. If a child is diagnosed with a condition that requires a specialist's care or treatment, another wait ensues because there are even fewer pediatric specialists.

This happens every day to countless children in large urban centers, but it's a chronic condition that is also magnified in rural areas throughout the state.

What's the solution? Reimbursement parity.

While it's hardly creative enough to be labeled "reform," the solution has already been in force since 1964 with the introduction of Medicare. For reasons lost in 45 years of administrative rulings, legislative amendments and budgetary adjustments, the Medicaid program currently reimburses physicians at 72 percent (65 percent for Missouri Medicaid) of what Medicare would pay. This doesn't make sense and is inherently unfair.

Why should one public program reimburse physicians who treat senior citizens at such a large premium compared to the other public program's reimbursement of physicians who treat children?

The correlation between the limited supply of pediatric specialists and their lower reimbursement from Medicaid is obvious but fixable. We need more pediatricians choosing the specialty career path to provide more timely and frequent access to children with special needs.

Now that we are on the cusp of health-care reform, it's time to address this largely forgotten disparity. The fix is not dramatic. Extending the Medicare physician reimbursement rates to the Medicaid program will be a major step toward addressing the physician access problem for our kids. It's also the right thing to do for Missouri's children.

About the author

Lee Fetter is president of St. Louis Children's Hospital.

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