By Andrew Graham
Chief Executive Officer, Clinic Service Corporation
ColoradoCare will have a negative impact on the Colorado Doctor community, and that effect could drastically influence the care Coloradans receive. Under the ballot initiative, a State-run Healthcare system would be implemented with fixed, payroll- based revenue provided by taxpayers, and will therefore require massive cost management oversight. As the bill directs, this cost management would be the target of the newly conceived 21 member, state insurance Board.
The line item that would pop up high on the Board’s list is provider reimbursement -- paying the Doc for the services they provide. Given the lobby interests of hospitals, major health systems, healthcare finance professionals, and drug and medical device manufacturers, individual and independent doctors will be especially vulnerable for the chopping block. It is a safe bet that the board would need to slash the physician reimbursement rate to bring the budget in alignment -- leaving every physician powerless to negotiate given areas of specialty, training, experience, tenure and expertise. Doctors already have little leverage with insurance payers. A state run system would halt any chance of fair negotiation. Worse yet, innovative Doctors will find somewhere else to practice their craft.
Physicians already feel the pinch as a result low Medicare and Medicaid reimbursement rates, which can be 20 percent less than what private health insurance pays. In recent years, many practices have limited the number of Medicare/Medicaid patients they accept, or they opt-out of treating this population altogether making it increasingly difficult for patients to find a provider that is willing to treat them. If ColoradoCare passes, many physicians may be forced to leave the state in order to stay afloat financially.
Colorado is already faced with a physician shortage problem, with rural and mountain regions being hit the hardest. According to a study by the Colorado Health Institute, El Paso County has one of the worst physician shortages in the state requiring a 54 percent increase in primary care physicians to reach a desirable ratio of 1,900 patients to every full-time physician. In Clear Creek, Gilpin Park and Teller counties a 44% increase is required. We are in a shortage, not a surplus. If even 10 percent of Colorado’s physicians left the state, imagine the strain it would place on the physicians that decide to stay. And recruiting new physicians to the state would be next to impossible.
Physicians that decide to stay in Colorado may opt to delve into “concierge medicine” to stay profitable, which is when a patient pays an additional annual fee to a practice (in some cases, upwards of $10,000/yr) to have 24/7 access to physician care and other complementary services, such as chiropractors and dieticians. This has been a growing trend in Canada where it is often exceedingly difficult to get an appointment with a family physician. The irony is that Colorado’s effort to give everyone care would result in the wealthy getting their own special healthcare system and only those that could afford it, would be able to jump the line.
Coloradans can’t afford to be complacent about ColoradoCare. This is a debacle we can, and must, avoid.