Charleston Daily Mail - Recipients Many for W.Va. Medicaid Expansion but Doctors are Few

By Zack Harold

If all goes according to plan, 277,000 West Virginians will have government-sponsored health coverage by 2016, as part of the federal Affordable Care Act.

And while that means thousands of state residents will have access to health care they previously lacked, patients still might find it difficult to see a primary care doctor.

While health insurance rolls will grow by leaps and bounds, the number of doctors in West Virginia likely will not.

About 183,000 West Virginians currently are enrolled in Medicaid or Children's Health Insurance Program (CHIP), according to an actuarial report commissioned by the state Insurance Commissioner's office.

By 2016, the report estimates 277,000 residents will have government-sponsored health insurance.

Evan Jenkins, executive director of the West Virginia State Medical Association, said that increase likely would cause growing pains in the state's health care industry. He said many doctors accept Medicaid, but most limit the number of Medicaid patients in their practice.

"A lot of folks will dedicate a certain number of patient slots for Medicaid. When those are filled, they don't take any new patients," he said.

About 2,100 primary care doctors in West Virginia accept Medicaid, said Penney Hall, Medicaid spokeswoman for the state Department of Health and Human Resources.

Neither Hall nor Jenkins are sure how many "slots" are available for Medicaid patients at those practices. But with thousands more people entering Medicaid next year, Jenkins said those spaces likely would fill up, leaving some patients unable to find a primary care physician.

There are other problems, too.

Medicaid reimburses doctors far less than private medical insurance or even Medicare, and Jenkins said physicians simply could not afford to build a practice on Medicaid patients.

At St. Francis Hospital in downtown Charleston, private insurance companies pay about 20 cents above cost. Medicaid only pays the hospital about 20 cents on the dollar.

"I'm not aware of any medical practice that could survive financially . . . solely on a Medicaid patient population," Jenkins said. "There's only so many hours in the day and so many patients you can see."

Massachusetts experienced similar issues when it expanded state-run health insurance in 2005.

Dr. Ronald Dunlap, president of the Massachusetts Medical Society, said the state has made changes to boost its physician workforce.

Colleges have increased the size of medical programs to produce more doctors. The state also has increased reimbursements to doctors, to make treating state-insured patients more appealing.

Urgent care facilities also have sprung up, Dunlap said, to capture itinerant patients.

"Early on, you're going to see more people in the emergency room because they don't have a primary care physician," he said.

Doctors and hospitals do not want to see non-emergency patients going to ERs, however, because they are vastly more expensive than a regular doctor's appointment and visiting the emergency room with a sore throat or earache can tie up resources for people with actual emergencies.

Dunlap said urgent care facilities began opening in Massachusetts following its health care expansion to draw patients away from ERs.

Increasing reimbursements to doctors also was an important piece of the health care expansion, Dunlap said.

In 2004, Massachusetts paid doctors $38.24 for a routine visit to an internal medicine physician. Now, doctors are paid $53.81 for that same visit.

"If you don't reimburse doctors well, they don't want to take on the risk," Dunlap said.

According to a 2011 report from the Association of American Medical Colleges, Massachusetts now has the third best doctor-to-patient ratio in the country. There were 7,144 actively practicing primary care physicians in the state, about one for every 928 residents.

West Virginia ranked 16th in that report, with about one primary care physician per 1,164 residents.

It's unclear what, if anything, West Virginia will do to address a potential doctor shortage.

Officials have not released details on how West Virginia will expand Medicaid under the Affordable Care Act, saying they are waiting on guidance from the federal Centers for Medicare and Medicaid Services.

CMS released a 606-page report Friday afternoon detailing rules for states' expansion of Medicaid, including benefits, open enrollment and cost-sharing.