New blow to OB coverage feared

Friday, Feb. 28, 2003 | 10:07 a.m.

CARSON CITY -- Gov. Kenny Guinn's budget calls for cutting payments to the doctors who treat the more than 100,000 Medicaid recipients in the state -- and some legislators feel it will worsen Nevada's medical crisis, particularly in the care of pregnant women in Clark County.

Nevada pays the fourth highest rate in the nation in Medicaid reimbursement to physicians.

State Human Resources Director Mike Willden told the Senate-Assembly budget committee Thursday that Medicaid also has the highest reimbursement in Nevada for obstetricians.

The state pays an average of $1,930 for prenatal care and a routine delivery of a baby, Willden said. Some private patients pay $2,000 to $2,500.

Guinn's budget would reduce the state reimbursement rate from $1,930 to $1,600, which is the level that Medicare pays obstetricians. Rates for other doctors would be reduced by varying rates, but Willden said the governor is reconsidering whether to go ahead with the planned reductions.

"We're in a true crisis regarding obstetricians," Sen. Ray Rawson, R-Las Vegas, said. "I don't think we have enough physicians to cover the babies born this year."

Assemblyman David Goldwater, D-Las Vegas, was also critical of the plan.

Assemblywoman Chris Giunchigliani, D-Las Vegas, noted that a new study shows only six obstetricians have left their practice in Las Vegas.

She said the situation is not as bad as some people are making it out to be.

A major difference of opinion exists on whether doctors are fleeing Las Vegas or closing their practices because of the rising malpractice premiums.

A legislative study released Thursday stated that only 35 physicians in Nevada, including six obstetricians, closed their offices last year during the controversy over rising medical malpractice premiums. It said that more than 300 new licenses have been issued to physicians in 2002.

The Nevada State Medical Association said that as of Jan. 28, 75 doctors had closed their practices and 13 physicians were in the process of pulling out. Association Executive Director Larry Matheis said 17 obstetricians closed their practices altogether and eight gave up their OB practice and only handle gynecology cases.

"We are losing doctors -- a substantial number of doctors," Matheis said.

The legislative study, requested by some members of the Assembly, said the state Board of Medical Examiners contacted each physician listed by the medical association as pulling up stakes. The examiners board said it could find only 19 who have left the state.

Karen Odell-Barber, a spokeswoman for a group called Keep Our Doctors in Nevada, said that more than 100 physicians have closed their offices in the last year. Also, 44 obstetricians in Clark County decided to stop delivering babies or close their office or retire, she said.

The coalition has gathered more than 90,000 signatures on a petition to tighten the laws on medical malpractice cases, shielding doctors from big judgments in lawsuits.

Rawson said he receives e-mail "from lots of women who can't get to see an OB and they are told (the doctors) are not taking new patients."

But pregnant women on Medicaid in Southern Nevada apparently are not having any trouble in getting prenatal and delivery care. Medicaid covers about 8,000 births in Southern Nevada each year.

Medicaid Chief Chuck Duarte said that a study done by his office in November showed that 92 of 100 women contacted reported they had "easy" or "very easy" access to an obstetrician.