Florida Health News

Legislators: Doctor payment system is upside-down

By Carol Gentry
7/30/2008 Florida Health News

BONITA SPRINGS – Florida, like the rest of the nation, needs to shift some spending from acute-care settings to primary and preventive care, two legislators who sit on the Florida House Health Care Council say. Putting all your resources into end-of-the-line treatment is like trying to bail a sinking boat instead of plugging the leak, they said.

Hays

“Why are costs continuing to escalate? Because money’s not going into primary care,” said Rep. Alan Hays, R-Umatilla.  Payment systems and medical education incentives are backwards, he said, to the point that almost no new doctors aspire to go into primary care. Hays said he's embarrassed at how little the state pays the professionals who treat Medicaid patients. 

Democrat Kelly Skidmore agreed. "There's no pediatric dentist in Palm Beach or Broward County that will see Medicaid patients. They would rather see a patient for free than go through the red tape."

As they spoke to almost 200 community health workers and educators attending an annual conference Tuesday, Hays and Skidmore  sang the same tune on nearly every subject. They both said Florida should have created medical-residency slots instead of two new medical schools, since doctors tend to remain where they get their practical training rather than where they go to school. And they both said Medicaid's "reform" pilot -- requiring beneficiaries to be enrolled in HMOs -- was a mistake, because it put more people in between the doctor and patient.

"We don't need to add more layers to it, we need to delete layers," Hays said.

Skidmore

Skidmore added, "We didn't reform rates of payment to doctors; that's what needs reform the most. What we did do is confuse a lot of people and create a lot of hurdles in their access to care."

While there was no disagreement in defining the problem, it will hard to change the payment structure, they said. Raising pay rates for primary-care professionals means taking some away from powerful and entrenched interests that have powerful lobbies.

But it has to be done, Hays said. "If you see yourself in trouble, the first thing you have to do is stop what you're doing. Medicaid is the same way. We know it's not working."

To offer ideas on how to reverse the status quo, the Florida Association of Community Health Centers invited some of those behind a New York State primary-care collaborative to talk about the progress they're making in establishing, funding and staffing centers there. Organizers said the key to success was getting internal medicine and family-practice associations in the state to throw their weight behind the effort, working with the centers in a coalition. 

A similar coalition is in the works in Florida, association officials said. They hope to have an announcement about it in the fall.