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February 1, 2015

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Doctors group calls on Nevada to expand Medicaid, raise reimbursement rates


Leila Navidi

Dr. David Stewart puts a cast on patient Makenna Millett, 3, during his office hours in Las Vegas on Friday, Jan. 2, 2009. Dr. Stewart is one of just five pediatric orthopedic surgeons in southern Nevada. Because of cuts in the reimbursement rates, he and his partners are no longer accepting Medicaid patients

An association of doctors and medical students is recommending the state expand its Medicaid program, which treats low-income people.

But the Nevada State Medical Association, with 2,000 members, also says the state should increase the fees paid to physicians who treat Medicaid patients.

The fee schedule for doctor reimbursement is based on a 2002 standard, and Larry Matheis, executive director of the association, said that "more and more doctors can't afford to take Medicaid patients."

Gov. Brian Sandoval and the 2013 Legislature will have to decide if Nevada should opt in to the federal program to provide more medical coverage for low-income families.

So far, Sandoval has not revealed whether the state will expand Medicaid. Mike Willden, director of Health and Human Services, estimated the Medicaid numbers would grow by nearly 120,000 in the first 10 months of 2013. But the federal government will be picking up the tab for these added patients.

There are currently 309,000 Nevadans receiving health care under Medicaid, with the state paying part of the cost.

The association, in a position paper issued Thursday, says Medicaid should be expanded under President Barack Obama's health care legislation.

But the association said Medicaid is currently "significantly underfunded" and the current fees paid doctors and hospitals to accept these patients except in emergencies.

Doctors are finding they cannot afford to treat Medicaid patients with cancer and heart diseases or the delivery of babies, Matheis said. But he doesn't have an estimate of how much money it would cost the state to up the payments to doctors.

Adding to the problem is the shortage of physicians in Nevada. Matheis said steps are being taken to recruit more doctors and to make better use of current resources.

While the federal government will pay the full cost for an expanded Medicaid program through 2016, the state will then have to share in the expenses of Medicaid costs. And there is no federal reimbursement for state administrative costs.

Adding to the problem is the federal government's intention to reduce the amount of money paid to states to reimburse hospitals for care of Medicaid patients. The $47.3 million that is now sent to Nevada would be reduced to $45.2 million in fiscal year 2014 and to $44.8 million the following year.

One of the decisions to be made by the governor and the Legislature is whether the state will make up the federal cutbacks.

Bill Welch, president of the Nevada Hospital Association, could not be reached for comment.

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  1. I have seen reimbursement rates lower than 25% for some government insurance programs. Doctors are dropping out at alarming rates and some choosing to change professions altogether. If this continues too many providers will be fee for service only.

  2. Interesting comment BRASS. Your perspective is all about money and providers.

    Not one word about patients, their needs, or understanding the extreme limitations they are in, especially those on Medicaid.

    Not a word about the provider fraud that factors into the funds available for disbursement.

    Not a word about the provider speculation of fees that has helped skew the reimbursement systems for many decades.

    $125 for 10 mins with a PCP, or $500+ for 20 mins with a Consultant seems excessive charges to me. Who set those fees? The provider!

    Keep in mind that it now costs about $15,000. a year for a family insurance plan. Do you realize that is a huge chunk of annual income for many people, thus the growing number of uninsured? Also, realize that providers have become dependent on the healthcare insurance industry, private and public, for their guaranteed incomes. If they leave, it is because they can no longer count on the money they once did. Result, tough luck to the patients. Says something about what motivates them.

    Providers get hefty deductions for multiple items, including operating expenses of all kinds, as well as other tax avoidance activities, that reduce the amount of income taxes they pay.

    In a global economic crisis, it is understandable that more people would need Medicaid. Thirty plus years of wage stagnation didn't help either. Do providers think they would be suffering no effect of this?

    Providers would abandon patients and leave them with no healthcare because they cannot afford to pay the fees they set for themselves? Because the provider can't continue to live in the style they are accustomed to?

    Personally, I would rather receive care from physicians who see people first over money. I would trust them more to have my interests in mind.

    In my opinion, after a lifelong career in healthcare, there is no solution to both the economic cost and quality of healthcare other than a single payer universal healthcare system.

    I know this would kill the chicken laying the golden eggs of healthcare. I also know there are people who would enter the professions, or come to the US to take up practice, because they truly want to serve others first, and profit second, rather than the other way around.