Maryland Faces Shortage of Specialists for Rural Medicaid Beneficiaries; Low Reimbursement Rates Blamed

Many specialists in rural areas of Maryland "refuse" to participate in the state's Medicaid program, maintaining that "it doesn't pay enough," which often forces patients to travel outside their counties to receive care, the Baltimore Sun reports. According to Donald Blanchon, CFO for the medical group Maryland Physicians Care, "recruiting physicians, especially specialists, continues to be a challenge" in rural areas with the state's low reimbursement rates. Dr. Donald Wilson, dean of the University of Maryland School of Medicine, which lost $9 million last year treating Medicaid beneficiaries, said that doctors "get paid a lot less" for treating Medicaid patients than for treating privately insured or Medicare patients. A "routine" office visit costs about $44 per patient, he said, pointing out that private insurance pays about $45 per visit, while Medicare pays $38 and Medicaid pays only $17. "To globally solve the issue, Medicaid has got to have a dramatic increase in physician reimbursement levels," he said. Although physicians 10 years ago often could "make up" for low Medicaid rates by raising rates for other patients, managed care has "fixed" their rates, the Sun reports. Maryland Secretary of Health and Public Hygiene Dr. Georges Benjamin, who oversees the state's Medicaid program, said that "it's time for us to pay a lot more attention to physician fees," adding, "The doctors are the bedrock of this system, and it's very clear to me they've said, 'Uncle.' We have a responsibility to support them." However, while the state will likely boost reimbursement rates, he said that "its dimensions are unclear and its implementation is months away at best." Dr. Brian Corden, an Easton pediatrician, said that the state's low Medicaid reimbursement "violates federal law," which requires payments "sufficient to enlist enough providers so that care and services are available under the plan to at least the extent that such care and services are available to the general population in the geographic area." Benjamin disagreed, but added, "You should be able to get access to a specialist at a reasonable distance in a reasonable amount of time. To the extent that we aren't doing that, that's what we need to fix" (Salganik, Baltimore Sun, 7/29). For further information on state health policy in Maryland, visit State Health Facts Online.