If HB 3300 passes the Oregon legislature, health plans in Lane County enrolling-public sector employees, including teachers, will not be allowed to contract with primary care physicians who do not serve the Oregon Medicaid program, states AAPS. At least 15 percent of the physician’s practice panel must be receiving medical assistance, unless the physician can demonstrate that he has not been able to attract enough patients despite adequate effort to do so.
Oregon expanded Medicaid to 442,000 patients, including 44,000 in Lane County, its most populous county. But nothing was done to increase the availability of medical care. Some 13,000 people in Lane County still lack a primary-care physician, according to the Oregon Register-Guard.
“Basically, the law would use well-paying government employees as a reward to physicians who meet a quota for signing up poorly paying Medicaid recipients,” stated AAPS executive director Jane M. Orient, M.D.
Nationwide, nearly 50 percent of family physicians decline to participate in Medicaid, up from about 35 percent in 2009, according to a survey by the Merritt-Hawkins consulting firm. In Portland, the number of family physicians declining Medicaid doubled, from about 20 percent in 2009 to 40 percent in 2013. Such physicians would not be available to Oregon public employees under the proposed law. These patients would have to compete for appointment times with a smaller pool of physicians. The Medicaid obligation of 15 percent is based on number of patients, not time spent. Medicaid patients often have many chronic problems that take a disproportionate amount of time, observes Dr. Orient.
After the Affordable Care Act passed, the Oregon Health Plan, the Medicaid program, started paying the same amount for each patient, regardless of the number of visits or time required. This made OHP patients who need more than an occasional checkup a threat to the financial viability of a practice, especially a small practice, Orient pointed out.
Poor pay is not the only reason, or even the most important reason for shunning Medicaid, according to a recent survey of AAPS members. “Cost, hassles, and threats” were most important for 58 percent. Doubling the fees would cause only 15 percent of nonparticipants to sign up. One respondent cited the 40-page application form. Another said Medicaid money not only has strings attached but “heavy steel cables with felony charges any time they want.”
“The proposed law treats both patients and physicians like commodities,” Orient stated. “Coercion may get physicians to sign up, but it poisons the patient-physician relationship.”
AAPS is a national association of physicians in all specialties, founded in 1943.