Obamacare will strain medical resources

Hundreds of thousands of Ohioans will have access to health care in less than a year under the proposed expansion of Medicaid and federally mandated health coverage requirements, but the question still remains whether enough physicians and medical professionals will be available to provide care for all those new customers.

Residents gaining health coverage for the first time under the Patient Protection and Affordable Care Act will pile on top of the throngs of patients already burdening the health care system, plagued by long waits for appointments and quick doctor visits.

Adding hundreds of thousands of new patients will simply exacerbate the problem, some experts say, and compromise the quality of care, especially for those who cannot afford to pay for high-dollar private care.

“If we didn’t change anything we were doing, and we were to double our Medicaid patients tomorrow, we would be challenged to meet their needs because our physicians are very busy now,” said Jim Moffett, executive director of PriMed Physicians, one of Dayton’s largest physicians’ groups.

To address those concerns, PriMed, which provides primary care at 17 locations in the Dayton area, has adopted the Patient Center Medical Home model, which utilizes a team of caregivers to coordinate care across broad cross-sections of patients.

“We believe we will be able to expand our breadth of care and see more patients with our existing number of physicians as a result,” Moffett said. “But it’s hard for me to sit here and say that even with changing our care design that we’ll be able to handle a huge influx of Medicaid patients.

“But we believe if you’re going to be committed to providing care for the entire community, it includes Medicaid as well,” he said.

Not all primary physicians are so magnanimous: Only two out of three primary care physicians surveyed in 2011 were willing to accept new Medicaid patients, according to a study from the National Center for Health Statistics.

John Bowblis, a Miami University economics professor specializing in health care, said he expects even more primary care physicians to reject Medicaid patients as their numbers explode. Ohio is expected to add 275,000 poor and disabled residents to its Medicaid roles if a proposed expansion under the health care law is approved by state legislators.

“The big issue is that private insurance tends to pay higher rates than Medicaid and Medicare,” Bowblis said. “So if I’m a physician, and I’m limited in the number of patients I can see, I’m going to try to take the patients that pay higher rates first.”

Under the new health care reform law, physicians who treat Medicaid patients will get reimbursement rates equal to Medicare for primary care services. But those rates still are not as lucrative as most private insurance, Bowblis said.

“If I’m a physician attempting to maximize my income, I’m going to take those patients that reimburse at the highest rates, and, unfortunately, they’re not Medicaid patients.”

As more and more primary care physicians with private practices reject Medicaid patients, they are likely to turn to public clinics and hospitals that already care for the majority of Medicaid patients and the uninsured.

“If they reject those patients and they are going to come to our clinics, our job is to make sure we have the capacity to take care of them,” said Gregory Hopkins, executive director of Community Health Centers of Greater Dayton.

Hopkins said extending health coverage to more people with benefit the health clinics, because they will receive enhanced reimbursements for the Medicaid patients they already see and about a third of their patients who have no insurance.

“I’m hopeful that some portion of those patients will have the means to pay for their services going forward,’’ he said. “That gives us the opportunity to have more money to expand and hire more physicians. That’s how we can actually add capacity.’’

But they are already busting at the seams, and there is no guarantee they can add facilities or find doctors fast enough to accommodate all the newly minted Medicaid patients.

The Association of American Medical Colleges recently reported that the United States would need about 30,000 more primary care doctors than it already has by 2015, a year after health care reform kicks in fully.

“I’m not suggesting that we will automatically have more capacity; we don’t have a whole lot of extra capacity today,” he said. “We’re already pretty much maxed out for an adult patient.”

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