The return of doctors in white coats on Wednesday brought issues new and old to the General Assembly.
By Hyun Namkoong
Familiar topics such as Medicaid reform and expansion and improving access to care were on physicians’ agendas when they met with lawmakers Wednesday at the General Assembly.
Newer topics such as cuts to Medicaid reimbursement and reform of the rules that govern hospitals also floated around during their conversations with legislators.
Diane Hanke and Robert Henderson are physicians who drove from Asheville to meet with representatives. They said the western part of the state is often overlooked when it comes to ensuring access to care.
Both said high levels of poverty, geographic barriers such as mountainous terrain and a disproportionate number of residents who rely on Medicaid negatively impact care.
Miriam Schwarz, executive director of the Western Carolina Medical Society, said recruiting people to practice in the mountains is difficult due to a lack of resources and a preference among people to live in more urban areas.
“We really need to have resources and reimbursement to keep people [in the west] engaged in helping the community,” she said. Hanke estimated that some 80 percent of residents in the western region rely on Medicaid or Medicare. She added that most counties in Western North Carolina don’t have community clinics, putting a strain on emergency departments.
Physicians who receive Medicaid payments face a 3 percent retroactive cut from the state going back to January 2014, something that High Point physician Ric Leinbach said would be especially detrimental to small rural practices. “Not everyone’s going to make it,” Henderson added. “We already lose money on Medicaid patients.”
Hanke and Henderson said inadequate reimbursement for Medicaid patients is causing many physicians in Western North Carolina to stop accepting Medicaid or to retire early because they can’t afford to practice.
Henderson said fewer health care providers in a region of the state that already faces physician shortages could result in worse health outcomes and even higher inappropriate utilization of the emergency department.
Eileen Raynor, a pediatric surgeon at Duke Children’s Hospital, said low Medicaid reimbursement rates affect private hospitals too.
“I see a lot of Medicaid patients because they can’t get services in their home county [due to] problems with Medicaid reimbursement,” she said.
Certificate of Need
Raynor said House Bill 200 and the certificate of need issue brought her to the General Assembly to meet with legislators.
The certificate of need statute requires providers or hospitals to first get approval from the Department of Health and Human Services to add or upgrade facilities so that services aren’t unnecessarily duplicated in the same area. The rationale behind a certificate of need is to control the costs and utilization of services.
But some providers disagree.
“We have the most restrictive rules in the United States,” Raynor said. “[We’re] trying to allow access to drive down costs so that patients can have choices.”
“House Bill 200 is a relatively nice middle-of-the-road [compromise], where it loosens restrictions without completely eliminating certificate of need, because I think that would be detrimental to North Carolina,” she said.
HB 200 would exempt certain health care centers such as ambulatory surgical facilities and psychiatric hospitals from the certificate of need statute. It would also prohibit the state from restricting the number of operating rooms and gastrointestinal endoscopy rooms.