Four pediatricians say they’re packing up and leaving Franklin County because the Medicaid programs that insure about half of the community’s children aren’t paying them enough.
Two of the doctors work in St. Albans for Franklin County Pediatrics, which will close down completely. Another is leaving Mousetrap Pediatrics in St. Albans, and the fourth left Mousetrap earlier in the year and hasn’t been replaced.
The American Academy of Pediatrics of Vermont, which is loosely affiliated with the American Medical Association, says that will leave the parents of 6,000 children “scrambling for primary health care” among the northern Vermont county’s seven remaining pediatricians.
“Everybody’s going to work together and try to make sure that these kids get the care that they need when they need it,” said Dr. Barbara Frankowski, the president of the Vermont chapter of the American Academy of Pediatrics.
At her day job, Frankowski works as a pediatrician at the UVM Children’s Hospital in Burlington. The hospital has the same financial structure as the UVM Medical Center, and her pay is shielded from reimbursement rate changes.
She said practices in her area would gladly take Franklin County patients, but she said driving south from St. Albans to Burlington is not a realistic solution because some families can’t afford transportation and others may find it difficult to drive down with crying, sick kids in the car.
Most children in Franklin County use Medicaid, the combination state and federal program that historically reimburses doctors and hospitals at a lower rate than the federal Medicare program, which itself reimburses at a lower rate than private insurance companies do.
About 70,000 children in Vermont are on some type of Medicaid, according to the Department of Vermont Health Access. Nearly 63,000 of those kids qualify for Medicaid because their parents have low incomes.
When the Affordable Care Act expanded Medicaid to more lower-middle income people, the law also bumped up reimbursement rates, largely to family doctors and pediatricians who serve many enrollees. The higher rates lasted from Jan. 1, 2013 to Dec. 31, 2014 and have not gone back up in Vermont.
Dr. John DiMichele, who works at Mousetrap Pediatrics in St. Albans is leaving to take a job in North Carolina, owned by an out-of-state hospital system, where he will be an employee with a salary instead of a part-owner whose income is based on reimbursements.
“I’ve worked in Mousetrap for 16 years,” DiMichele said. I know my families very very well. I actually enjoy what I do. It’s actually a very very difficult decision to make.”
At Mousetrap, 69 percent of DiMichele’s patients in Vermont paid with Medicaid, and he said his income went down about 40 percent this year when reimbursements went down under the Affordable Care Act. The bills stayed the same, he said.
“I think had the Legislature maintained level funding over the past couple years, we wouldn’t be having this discussion,” DiMichele said. “It’s that simple.”
Dr. Kristen Connolly, who will leave when Franklin County Pediatrics closes, wrote her concerns a letter to Al Gobeille, the chair of Green Mountain Care Board, which regulates hospital budgets and spearheads health care reform.
“I firmly believe that action needs to be taken, and soon, or this trend will continue throughout the state,” the letter said. She asked the board, Gov. Peter Shumlin, and the Legislature to figure out how to reverse the 20-percent rate cut to Medicaid reimbursements.
Gobeille said in an interview that the Shumlin administration tried to keep Medicaid reimbursement rates steady with a 0.7-percent payroll tax, but that failed in the 2015 legislative session. He said the Green Mountain Care Board should do an entire “rate review” for Medicaid in the near future.
Allan Ramsay, a family doctor who sits on the Green Mountain Care Board, said reimbursement rates for primary care are one of the things that keep him up at night, but there is no data saying doctors are leaving the whole state.
“This issue of pediatricians leaving because of a payment model that is not working for them—we don’t want that to be a harbinger of health care reform in the future, in any way,” Ramsay said. “We can’t let that happen.”
