Mosaic Medical, a provider that receives federal funding to operate community health clinics in Bend, Redmond, Madras and Prineville, sees far and away the largest number of OHP patients in the region: Nike Air More Uptempo Low
have to find a new doctor.
CCOs prepared as best they could, but when the Affordable Care Act provision took effect that expanded Medicaid eligibility to 138 percent of the federal poverty level, some were flooded with more people than they could have anticipated.
Oregon officials projected Central Oregon's CCO would see 8,000 new OHP enrollees by the end of March. By the end of February, that number was already at 14,000, said John Ryan, executive director of the Central Oregon Independent Practice Association, an organization made up of providers whose leadership makes sure each clinic takes on a fair share of OHP patients.
Providers are paid to treat OHP adult patients at a per person, per month rate of between $20 to $25, said Ryan, of COIPA. They also can bring in additional reimbursement for services like immunizations and X rays.
"We do know the clinics that are saying 'no' after they have a smaller number," said Stephen Mann, president of COIPA's board of directors and a physician at High Lakes Health Care in Bend. "We have informal discussions about 'Take your share.'"
They can't find a doctor who will treat Gary's complicated disability, especially now that he's trying to apply for social security benefits.
Even before the Affordable Care Act expanded Medicaid, its beneficiaries have long struggled to find doctors to see them because of the program's low reimbursement rates.
If that doesn't happen, the providers get calls from COIPA.
That was the case at Central Oregon Family Medicine in Redmond, which sent its adult OHP patients letters in March telling them they had to cut ties in order to stay in business.
Central Oregon docs flooded with Medicaid patients
After the expansion flooded clinics with new patients, some doctors say they simply had to put an end to it.
"Everything is happening so fast as far as the expansion," he said. "The whole community is trying to grapple with it as best we can."
COIPA has 664 individual provider members at 110 clinics across Central Oregon. The group's contract with PacificSource directs it to monitor whether its members are seeing OHP patients, a dynamic that's caused friction with doctors who want more independence than COIPA membership allows.
In the Fredericks' case, the state's fast track enrollment process for OHP worked a little too well. Because the couple receives food assistance, they were automatically enrolled into OHP and they say it's been a nightmare ever since.
In general, smaller providers have a harder time treating OHP patients at that rate because they have fewer patients with private insurance to offset potential losses.
"It's great for people who have the occasional cold, who just need occasional things once a year checkups," Tricia said, "but for people who actually need active health care like us, it doesn't seem to be working."
But they liked Skotte and wanted to keep him. So while filling out her insurance application, Tricia Frederick made sure to stipulate she did not want OHP. She wanted PacificSource's gold or silver plan, which she could afford with tax credits.
They said their doctor, Daniel Skotte at High Desert Family Medicine in Sunriver, warned them straight away: If they got on the Oregon Health Plan the state's version of Medicaid they'd Nike Air Uptempo Size 13
The Fredericks are not unique in their struggle to get the care they need with their new OHP cards after being dropped from their original doctors. More than 42,000 people are now enrolled in OHP under the umbrella of Central Oregon's Coordinated Care Organization, the entity run by PacificSource Community Solutions that oversees the care and billing for patients in Deschutes, Crook and Jefferson counties and part of Klamath County.
Overwhelmed docs, miffed patients
Providers: From a hospital system and community health centers to hundreds of small clinics and Black Nike Vapormax individual doctors, providers vary widely in their size and capacity to take on OHP patients as well as in their sense of responsibility to do so.
By the end of February, COIPA's providers were seeing an average of 245 patients each, Ryan said.
Central Oregon Independent Practice Association: The nonprofit that individual providers must join in order to treat OHP patients.
Gaining an overall picture of the Medicaid expansion's success or failure is complicated by the fact that Central Oregon's CCO is operated by a number of stakeholders with their own agendas, each struggling to make it work for them.
The number of primary care physicians who accept Medicaid has declined over the years. In 2009, 65.4 percent accepted Medicaid, a number that dropped to 50.6 percent in 2013, according to a survey by the health care consulting firm Merritt Hawkins.
COIPA does not designate a specific number of OHP patients its members must see, but it does expect it to be a "reasonable amount," Ryan said.
PacificSource Community Solutions: The insurance company overseeing all patients within Central Uptempo Nike Blue
Oregon's CCO and reimbursing providers for having those patients on their rosters.
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