Las Vegas Sun

October 26, 2014

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Child specialists leaving Medicaid

CARSON CITY -- Twenty-five pediatric specialists in Clark County have resigned from the Medicaid program, forcing Nevada to send more children out of state for treatment, state officials said Thursday.

"It's made it difficult for children to get service," Charles Duarte, chief of the Health Care Financing and Policy Division said.

The specialists quit May 8 after the Medicaid reimbursement rates were cut by up to 50 percent.

"This isn't about a family physician not getting a few dollars more for an office visit," said Larry Matheis, executive director of the Nevada State Medical Association. "This is about a child coming into the ER who winds up needing heart surgery or cancer treatment and the doctors simply won't be there."

Since the reimbursement rates were lowered, the resignations have forced at least three children from Las Vegas to be flown by air ambulance to California or Arizona for treatment, officials said.

Dr. Philip A. Riedel, a neonatologist and medical director of the intensive care nursery at Sunrise Hospital and Medical Center, said one newborn from Valley Hospital Medical Center who required brain surgery within the last week had to be airlifted to a Southern California because there was no surgeon in Las Vegas to handle the operation.

Last year 56 children from Las Vegas were sent out of state for medical care and rehabilitation. Most of the cases involved complex medical procedures such as transplants.

Duarte said it "is not our preference" to transfer the children out of Las Vegas.

In addition to delaying treatment and adding stress to patients and families, out-of-town treatment also adds thousands of dollars onto the cost for each patient, officials said.

Gov. Kenny Guinn and State Human Resources Director Mike Willden have asked for suggestions about how to solve what appears to be a growing crisis over the reimbursement rates, Duarte said. A decision is expected by Wednesday.

Willden said the state has been working on a solution that he thinks will be acceptable to most of the doctors. But he declined to say what the proposal is until it is final.

Prior to having their reimbursement rates raised, some pediatric specialists in Nevada, mainly surgeons and radiologists, were being paid twice what is allowed for Medicaid in other states, Duarte said. But he said 75 percent of the reimbursements for physician services for Medicaid were raised.

To reinstate the rates for the medical specialists whose rates were raised would cost the state an extra $3 million a year, he said. If he returned the rates to their former level, Duarte said, he would have to cut other programs.

"We would be robbing Peter to pay Paul," Duarte said.

He said the Legislature, now in special session, could reopen his budget to make further reductions. Willden also was reluctant to announce a decision before the Legislature adopts a tax plan to fund the state's full budget. He said the Legislature, looking for reductions, could re-open the Medicaid budget.

"We've taken out all we can," Duarte said.

The 25 pediatric specialists who resigned from the Medicaid program represent a "major share" of the doctors who handle their particular kinds of work for the government subsidized medical program, but Duarte said he did not know how many were left in the program. Willden said he has heard there may be 35 to 40 who were signed up with Medicaid.

Willden said he asked the physicians not to withdraw from the program, but most of them submitted resignations, and all but two or three are not treating any Medicaid patients. He said the resignations for the remaining two or three become effective later this month.

Sunrise Hospital's Riedel said Nevada should follow the lead of other states and provide stipends to specialists to offset costs not reimbursed by Medicaid.

The valley's pediatric specialists are essentially small business owners, Riedel said. The cut in Medicaid reimbursements means many of them are losing money for every procedure they do.

"Yes, they have compassion. Yes, they care about treating children," Riedel said. "But there comes a point when they simply can't stay in business any longer."

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