Lack Of Doctors Leaves Children In Limbo

Thousands Qualify For Free Health Care But Can't Find Participating Pediatricians

Last updated Monday, November 26, 2007 10:09 AM CST in News

By Doug Thompson
The Morning News

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"They wanted everything: proof of where I live, my income, where I was working, phone number and references. References -- for health care? Then there was proof of birth in the U.S. and that I had Social Security."

Then came the waiting for an answer to the applications.

"It was two months of calling and asking and going over to offices six or seven days a week," Kibin said. "Finally, when you'd applied, you'd ask when you'd get your care. 'Next week.' You'd go back. 'Next week.' It was a broken record."

Kibin persevered. Both of his children are now eligible for ArKids First, the health care program for children in working, low-income families.

That leaves an estimated 7,000 eligible but unenrolled kids left in Washington and Benton counties. The bottleneck is getting a primary care doctor who takes the Medicaid program, Kibin said. That's the first step to getting enrolled.

"We think it's more than that, but we rounded down," said Cambre Horne-Brooks, director of development for the Community Clinic of Saint Francis House. The clinic in Springdale provides health care to those who can least afford it.

"Our best estimate from the numbers given to us by the state is that there's 3,400 in Washington County and 3,700 in Benton County," Horne-Brooks said.

A patient must have a primary care physician to join ArKids, which covers children whose family income is too high to qualify for state-administered Medicaid, but still within 200 percent of poverty and have no health benefits provided by their parents' jobs.

Those 7,000 children still waiting are a result of the biggest health care problem in Northwest Arkansas, said Kathy Grisham, community clinic director: "There aren't enough doctors."

Larry Shackelford is executive director of Medical Associates of Northwest Arkansas. The physicians' group represents about 75 doctors in the region. While the area needs more doctors -- like most of the rest of the United States -- the shortage for ArKids and other public health programs would be greatly relieved by more doctors taking a greater share of those patients.

"The problem is that a level 3 office visit, which is a middle-of-the-road office visit, is reimbursed at the rate of $36 for a Medicaid patient, $54 for a Medicare patient and around $68 for a private pay patient," Shackelford said. Other medical procedures are priced in the same proportions, he said.

"You've got to have a viable rate of return to stay in business," Shackelford said. "If somebody puts a cap on the number of Medicare or Medicaid patients, it makes it a greater burden for everyone else."

Difficulty getting to a primary care doctor also increases the problem of patients who don't get care until absolutely necessary, Shackelford said.

"You don't have to have a primary care provider if you're in the emergency room," he said.

"You could make an argument that it costs more to treat people at the emergency room than it would to insure them and provide check-ups and preventative treatment," he said.

The Medicare program divides the country into more than 100 areas and has different reimbursement rates for each of those areas, Shackelford said. Arkansas is "next to last, with only Puerto Rico behind us, in Medicare reimbursement," he said. Medicaid reimbursement is set at a percentage of Medicare reimbursement for the same procedure, at discounts 30 to 40 percent lower.

The situation is at risk of getting much, much worse, Shackelford said. The funding of child health insurance programs is currently subject to a budget battle between the White House and Congress. Within that legislation is a provision to renew current reimbursement rates for all Medicare payments, he said.

Unless that provision is passed, all Medicare payments for medical procedures will be cut 9.9 percent, Shackelford said. Medicaid payments, based on Medicare rates, will be reduced too.

Beyond primary care, Children's Hospital in Little Rock has recently opened a clinic in Lowell and brings specialists to it on a regular basis, said Dr. Charles Ball of Northwest Arkansas Pediatric Clinic. This is a very big improvement, he said.

Yet Grisham said: "You have to have a primary care physician to get referred to specialists. That's the key."

Kibin knows how hard it can be to get a pediatrician to accept ArKids patients. He persisted because he wanted health coverage for his children and greater financial security for his family. Kibin takes home $255 a week, he said, working in the sanitation division at Georges Inc., a poultry company.

His son, Louis, age 2 years, and daughter, Anglynn, age 1, were enrolled by early November -- just before Anglynn caught what appears to be a cold.

"Now we know that if something happens we can cover the bill," he said.

"Wherever you go to get health care, people ask for proof of insurance," he said. "That's the first thing they ask."

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