Physicians of the Vermont Medical Society (VMS)have spoken out in opposition against Vermont Gov. Peter Shumlin's (D) designs to expand the state's taxpayer-funded Medicaid program for low-income residents.Shumlin also wants to add Catamount health insurance to the planned mix.
Physicians are upset with Shumlin's supposed "savings" plan with the Medicaid proposal in the driver's seat. They are also troubled by the Catamount plans.
"The expansion of Medicaid without regard to income violates the social contract between the state and physicians who have accepted Medicaid's below-cost reimbursement because they wanted to make sure that those in the greatest needed received care," said Paula Duncan, M.D., VMS president. "Increasing the number of Medicaid patients while paying doctors substantially lower than all other payers would be financially devastating to physicians in the state. Many simply wouldn't be able to afford to keep their doors open to new Medicaid patients."
Duncan is a professor of pediatrics at the University of
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Vermont College of Medicine, where she is the Youth Project director for the Vermont Child Health Improvement Program.
VMS members said greatly expanding the pool of Medicaid-eligible residents in Vermont, even to those with high incomes would have a chilling effect on rural doctors. The governor's plan would see a 32.8 percent cut in reimbursements to physicians treating Catamount Health Plan patients.
"Doctors dedicate their lives and careers to caring for their patients, but unfortunately they are not immune from economic realities," said Dr. Duncan. "Expanding the Medicaid rolls will no doubt exacerbate the already tough economic situation that many physician practices find themselves in. The end result could be more Vermonters with Medicaid but without a doctor in their area who can afford to see them."
Critics like Dr. Duncan and most VMS phsyician members cite the incompatibility of the budget proposal with the goals of the governor's health care bill, most notably that eliminating the shift of costs between the payers of health services by ensuring reimbursements to health care professionals would be sufficient.
A VMS news statement stressed that when the society agreed to support the creation of Catamount, "it was with the understanding that the physician fee schedule would be established in statute to equal the 2006 Medicare fee schedule, plus 10 percent, with an annual update based on the MEI (Medicare Economic Index).
"VMS would have strongly opposed the legislation creating Catamount if its physician reimbursement had been based on the Medicaid fee schedule. The proposed change represents a broken commitment," according to a VMS statement.
The governor has gone on record claiming his proposal will save Vermont money. But VMS members remain skeptical that Shumlin will be able to find savings in health care that make up for the $176 million budget shortfall.
Paula Duncan, M.D.: "Expanding the Medicaid rolls (in Vermont) will no doubt exacerbate the already tough economic situation that many physician practices find themselves in. The end result could be more Vermonters with Medicaid but without a doctor in their area who can afford to see them."
Photo courtesy VMA