Tuesday, November 28, 2006


And California's Democrat legislators want to subject Californians to more of this!!

The physicians at Roseville Pediatrics say they almost stopped seeing Medi-Cal patients this year out of frustration. It took a year and a half for state workers to issue the practice a new Medi-Cal billing number after a move, said Dr. Ravinder Khaira, one of the two pediatricians at the clinic. During the wait, Khaira said, the clinic was forced to float about $100,000 the state owed for services to low-income patients enrolled in the government health insurance program for the poor. On top of that, workers handling the application were unreachable by telephone, Khaira said. The only way to communicate was via regular mail. "The only reason I would even consider remaining with Medi-Cal is because we want to take care of the kids," Khaira said. "The sheer volume of paperwork that needs to be done is at least triple what would be necessary for commercial insurance."

State officials dispute some details of Khaira's account, saying they have computer records showing the delay was only about a year. They say some of that delay occurred because the clinic filled out the forms incorrectly.

But Khaira's story illustrates one of the hurdles the state faces in trying to attract and retain doctors in the program, which covers more than 6 million poor Californians. According to the California Health Care Foundation, Medi-Cal has about 46 primary care doctors for every 100,000 patients. The standard for Medicaid, the federal program that funds Medi-Cal, is about 60 to 80 doctors per 100,000 patients. The strains on the system could grow if the number of people receiving Medi-Cal continues to increase. Gov. Arnold Schwarzenegger has said he wants to ensure all children eligible for the program are enrolled, which could add hundreds of thousands of new patients to the system.

Stan Rosenstein, the state's Medi-Cal director, said the Department of Health Services recently has made great strides in cutting down delays for doctors seeking to be certified to treat Medi-Cal patients. Two years ago, there was a backlog of about 11,000 applications from doctors waiting to be approved, and the wait averaged six months. Now, after the state hired management consultants and temporarily redirected staff members, there are about 3,000 pending applications, and the average wait is down to about 35 days, Rosenstein said. "Approximately 35 days is as good as we're probably going to get," Rosenstein said. "That is a very good status. The application processing takes time."

Part of the reason it takes time, Rosenstein said, is that the state has enacted new controls to make sure that doctors aren't committing fraud. Still, the system is not equipped to handle problems quickly. When there is a glitch with an application, the state communicates with doctors through the mail. Khaira said he tried to call a phone number listed on the enrollment forms and got a recording. "We are currently unable to staff the call center due to budget reductions and loss of staff," said the message, which was still on the Department of Health Services provider information line as of this week. "You may communicate directly to the branch using regular mail."

Rosenstein said the message was "terrible customer service." He said he had directed his staff members to take it down earlier this year. "I had thought it was changed, and we will get it changed," he said. Under the current system, Rosenstein said, doctors can leave a message and have their calls returned, though there is no way for them to be connected directly for live assistance.

In September, the Legislature approved Senate Bill 1353, which would have enacted some steps to streamline the doctor enrollment process. The governor vetoed the measure, sponsored by the California Medical Association, saying it could potentially create opportunities for fraud in the $33 billion program. The CMA is still hoping for improvements. "We think you can create a more efficient process and still prevent fraud," said Karen Nikos, a spokeswoman for the organization, which represents doctors. "We're having a hard time convincing physicians they should serve in these communities. It's the red-tape issue that the government is so famous for."

Rosenstein said the state is concerned about keeping an adequate number of doctors available to serve Medi-Cal patients. "We want to attract physicians, and we want to make it easier," he said. "We just have to have the balance we need to have strict fraud control."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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