Medicaid pay fails to satisfy doctors
Hawaii physicians caring for Medicaid/QUEST patients will receive higher payments this year for many services, but the new fee schedule still is inadequate, a hospital official said.
The two most frequent billing codes used for patient visits were not changed to reach 100 percent of Medicare rates, said Dr. Virginia Pressler, Hawaii Pacific Health executive vice president of strategic business development.
She said the hospital company's staff is going through the new fee schedule, posted by the state Department of Human Services on Med-quest.us, but at first glance it does not meet the Legislature's requirements.
Lillian Koller, state Department of Human Services director, said some fees were already at 100 percent of the 2006 Medicare rates, and all those below 60 percent were raised to 79.5 percent of the Medicare level.
She said 250,000 out of 615,000 billing codes used by Medicaid/QUEST physicians were changed, but the Legislature did not provide enough money to adjust all the codes.
The Legislature appropriated $8 million last year for the 2007-08 fiscal year and another $8 million for this fiscal year -- each drawing about $10 million in matching federal funds -- to raise payments for Medicaid/ QUEST doctors to the Medicare level.
Koller said she received a letter from six legislators in June saying they expected the appropriations to raise Medicaid/ QUEST fees to 100 percent of Medicare rates.
She said she responded by letter to each of them and gave a report to the Legislature this year that it would cost nearly $13 million in state funds, plus federal matching funds, to raise Medicaid rates to the Medicare level.
The Lingle administration withheld the $8 million earmarked for increased reimbursements last year, causing a furor among health and physician groups concerned about health care access for poor and low-income residents.
Many doctors are retiring, leaving the state or cutting back on their practice because of low reimbursements, which also make it difficult to recruit new doctors, said Senate Ways and Means Chairwoman Rosalyn Baker (D, Honokohau-Makena).
"They say they don't want to take Medicaid or Quest (patients) or even Medicare because reimbursements are not adequate," she said. "The whole purpose of this was, if government payers are up to speed, we've got more clout with other third-party payers to get reimbursements up to speed."
The administration did not increase the payments last year because a lengthy process was involved to implement the law (Act 284), and Budget Director Georgina Kawamura felt providing increases back to July 1, 2007, would amount to a bonus on claims already paid, Koller said.
However, she said new rates were implemented for the 2008-09 fiscal year, effective July 1, including physician increases and cost adjustments for inflation.
If patient visits are not billed at 100 percent of Medicare rates, Baker said, "they really haven't gotten to the core of the problem, which is making sure the basic services are reimbursed appropriately so people can access health care."
Pressler and Baker said the law required the administration to ask the Legislature for any additional money necessary to meet the requirements, and that was not done.
"We funded it but it was our best guess," Baker said. "We were not getting any assistance from the administration for information."