by Robert Mitchum, ChicagoTribune
March 10, 2008
When Joel and Beth Jones' daughter, Sommer, was diagnosed with juvenile diabetes four years ago, the family's medical coverage forced them to pay large fees for doctor visits and medication expenses.
The All Kids program, launched by the state of Illinois in 2006, helped alleviate the Joneses' health-care costs. But under that program, they found themselves with a new problem: finding a doctor who would accept Sommer's state coverage.
"The doctors would tell me, 'We don't take Medicaid,'" Beth Jones said. "Even her endocrinologist that she was currently seeing said, 'Sorry, we don't get paid enough from state [reimbursement].'"
Sunday, several Chicago pediatric physicians speaking at a news conference at Children's Healthcare Associates in Lincoln Park said the Jones family's story is becoming increasingly common in Illinois. Doctors urged the state to increase Medicaid reimbursement rates for pediatric specialists, warning that a failure to do so may lead to shortages of endocrinologists, cardiologists and other specialists able to treat Illinois children.
"I think that we're watching the evolution of a crisis in health care," said Dr. Daniel Johnson, a pediatric infectious disease specialist at the University of Chicago Medical Center. "At this point, the cost of care so outweighs the reimbursement that children are having difficulty finding specialists who can treat their disorders."
At issue is the amount of reimbursement pediatric specialists get from state and federal funds after treating a child insured under Medicaid or the All Kids program, which uses Medicaid funds. Currently, Illinois specialists said, they are repaid just 33 cents for every dollar they spend on such patients, one of the lowest reimbursement rates in the country.
Physicians worry the increasing gap between medical costs and Medicaid reimbursement rates will make it more difficult to attract new pediatric specialists to the state. Many also worry specialists will leave Illinois or stop accepting children who are covered by Medicaid or All Kids.
"This does not just affect poor children," Johnson said. "As our ability to recruit successful sub-specialists to come into the state declines, all children will lose access to care."
Beth Jones said she spent three weeks searching for an endocrinologist who would accept Sommer's All Kids insurance before finally finding one, but the office requires a long drive from their St. Charles home.
"We're blessed to have them as primary-care physician for diabetes, but we have to drive an hour and a half to get there," Jones said. "To wake up a 5-year-old at 6 a.m. in the morning is a feat, but, of course, we will do it."
Physicians hope legislation submitted to the Illinois General Assembly will help bring reimbursements closer to costs, allowing pediatric specialists, among other practices, to continue seeing All Kids and Medicaid patients.
But adjustments for pediatric specialists alone could cost the state $75 million, said George Hovanec, former state Medicaid director who is a consultant for Children's Memorial Hospital.
That hefty price tag may make it difficult for the state, already facing budget problems, to fix the problem any time soon, said Rep. Rosemary Mulligan.
"It's definitely a problem. I don't think [doctors] would be going to the general public if it wasn't a great need," Mulligan said.
