by Maura Possley, Staff Writer Southtown Star
January 22, 2009
The paperwork Kushalraj Singavi nearly signed in desperation late last year is still tucked away in his files.
With one child in medical school and another in college, a home to maintain and a speech language pathology practice to run, Singavi turned to refinancing his Joliet residence when reimbursement payments from the state for the care of Medicaid patients wasn't showing up.
It was December. He was awaiting payment for services in October.
"I'm stuck," Singavi said. "I cannot run my household."
October's delayed payments finally arrived that month, and since, payments have run about a month behind; November's arrived in early January, December's is still to come. Singavi declined to disclose how much he's owed, mimicking many doctors' hesitance to stay mum on the debt.
He still hangs onto the possibility of refinancing, unsure how the reimbursement cycle will play out in the years ahead.
"They keep talking about money is coming and then they say money is not coming," Singavi said. "What the truth is, I can't understand."
State owes $1.5 billion
Health care providers have sat idling for months as they wait for overdue reimbursement payments and bills pile up.
Among them are pediatric sub-specialists like Singavi, who sees Southland patients under the Early Intervention program for infants and toddlers up to age 3 as part of the governor's All Kids health care program. About 80 percent of his toddler patients are on Medicaid.
Compounding the problem of delays, providers receive about half of what actual office visits cost, they said.
"Doctors cannot afford to see Medicaid patients because they cannot afford to lose money," said Dr. Gerardo Reyes, a physician in Joliet's Provena St. Joseph Hospital pediatric and pediatric intensive care units. "Not getting that money represents a serious cash flow problem for them. Eventually, you have to pay your cost and look out for yourself."
The result, doctors contend, is more disastrous then unpaid and upset physicians. The delayed payment cycle trickles down to the state's most vulnerable - in the case of these providers, it's children.
There is currently about $1.5 billion the state owes in Medicaid billing, according to the comptroller's office and the Department of Healthcare and Family services. Half of those payments are fewer than 30 days old, according to a department spokeswoman.
Cash flow woes
Doctors have long lamented over the inefficiency of reimbursement, saying Illinois is at the bottom of the heap nationally for its payment cycle, though no studies to date back up the claim.
In fact, officials at the former St. Francis Hospital in Blue Island (now MetroSouth Medical Center), cited rising Medicaid debt as a factor in the company's decision to shut the hospital's doors.
Dr. Amar Dave, an Ottawa, Ill., pediatrician, was one physician willing to disclose his Medicaid debt, putting the figure for his office at more than $250,000. Of that, nearly $70,000 is over due by 120 days, he said.
"This is what was billed to them - not what they will give me," the doctor said.
For a standard office visit, Dave gets about $28 from the state, which represents about half to less than half of the actual cost.
"Most of us have a business to run not just to practice medicine," he said.
Gov. Rod Blagojevich's office said earlier this year that increases to reimbursements for these pediatric providers was coming in mid-February, instead of Jan. 1, though the state agency that oversees that process could not provide details last week on how much will be allocated or from where the dollars will come.
That announcement came after $8 million in Medicaid reimbursement became an issue in the governor's December arrest. Blagojevich was ready to dole out the $8 million if he received a $50,000 campaign contribution from the chief executive officer at Chicago's Children's Memorial Hospital, a representative of the pediatric sub-specialist group. When that didn't materialize, he considered reneging, according to an affidavit filed in his arrest.
"Between what's happening with the governor and the economy in general, it's a challenging time to be looking into more money for the Medicaid program," said Scott Allen, executive director of the Illinois chapter of the American Academy of Pediatrics.
Providers aren't holding their breath.
And they warn that as a recession continues and more people are laid off, the number of uninsured and Medicaid patients will balloon.
"Sooner or later, somebody's going to have to come up with tough decisions," Reyes said.
Maura Possley can be reached at mpossley@southtownstar.com or at (708) 633-5993.
