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Maryland doctors warn about Blues' pay cuts

The medical society says pay reductions from the state's Blues plan threaten physician supply and patient access.

By Emily Berry — Posted Dec. 1, 2008

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MedChi, the Maryland State Medical Society, is warning that insurance reimbursement cuts planned for 2009 will make it harder for physicians to stay in business, even as the state's supply of physicians is waning.

The state's largest nonprofit health plan, CareFirst BlueCross BlueShield, recently issued fee schedules to doctors that include cuts -- called "adjustments" by the insurer -- to take effect in 2009.

The Blues' reimbursements are the latest move in health plans' "race to the bottom" of reimbursement levels, said MedChi President Ron Sroka, MD, a primary care physician from Crofton.

He said CareFirst and UnitedHealthcare, which together control 80% to 85% of the commercial market, compete to pay the least to doctors, although the state has communities with some of the highest costs of living in the U.S.

CareFirst spokesman Mike Sullivan said the plan has "a fundamental responsibility to make sure our members aren't paying more than members of other plans."

But that mentality is hurting patients by driving doctors out of Maryland or out of clinical practice, Dr. Sroka said.

Steve Johnson, interim executive director of MedChi, said state physicians are increasingly turning to "concierge" or retainer-based arrangements with patients to avoid falling reimbursements.

CareFirst raises payments for some primary care visits but not without an offset elsewhere, Dr. Sroka said. "In the long run at best we're coming out even, but more likely we are coming out below our previous reimbursement."

Combined with pay that is lower relative to the rest of the U.S., Maryland has an aging doctor population nearing retirement and a population of aging patients who need more care, Dr. Sroka said.

Sullivan said CareFirst is helping ensure patient access. Gov. Martin O'Malley appointed CareFirst CEO David Wolf to his Task Force on Health Care Access and Reimbursement, which is studying how the state could ensure an adequate supply of doctors.

The task force will release recommendations early next year.

CareFirst supports some measures being considered, including med school loan repayment help. But, Sullivan said, the insurer and physicians still have some fundamental differences of thought.

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