Physician numbers at odds

CareFirst disputes study that indicates impending shortage of doctors

Miller then came under fire by members of the Governor’s Task Force on Health Care Access and Reimbursement by saying the best estimate CareFirst could muster is that possibly 16,500 full-time doctors practice in the state. That number, based on company payment records, is considerably more than the approximately 10,000 reported by a joint study released last month by the state physician association MedChi and the Maryland Hospital Association.

‘‘I’m not saying I’m discrediting their report,� Miller said. ‘‘I’m saying that there is no way to count the number of physicians in Maryland by identifying them as full-time docs.�

The task force, comprising legislators, physicians and health care officials, was created by statute last year to examine data and trends on insurance reimbursement rates to providers and assess their impact on health care.

But Miller said his report indicates there is no need to reform physician delivery and payment systems by insurers.

Task force member Sen. Robert J. Garagiola (D-Dist. 15) of Germantown said getting a second set of numbers might cause the group ‘‘a little frustration because we want to make an apples-to-apples comparison. We got one report a month ago and the second set of numbers was completely contrary to that.�

Nancy Fiedler, a spokeswoman with the state hospital association, took issue with Miller’s assertion.

‘‘Our study showed that [Miller’s] assumption is disproved by the aggregate numbers that we found,� Fiedler said. ‘‘Our study takes the number of physicians and for the first time backed out the research doctors and then double-checked their percentage of time with patients with the hospitals.�

Thomas Lawrence, chief medical officer at Peninsula Regional Medical Center in Salisbury, told the task force his county can expect a shortage of 98 physicians within five years.

Filling those slots would generate 829 total jobs and $74.3 million for the Eastern Shore economy, Lawrence said. He suggested a disconnect between the financial health of Maryland’s medical insurers and its physician community.

‘‘Meanwhile, United HealthCare had an operating margin of 11.5 percent last year,� he said. ‘‘It is a very, very healthy business and would be the envy of any of the hospitals on the Eastern Shore.� United HealthCare of Minneapolis had a national operating margin of 10.4 percent, according to published reports.

CareFirst and United HealthCare of Maryland are the leading medical insurers in Maryland.

The task force commissioned the initial study because state officials fear Maryland is becoming less competitive in attracting and retaining physicians. A presentation of the study report to the Senate Finance Committee on Wednesday concluded that much of the state faces physician shortages that could become critical to health care and lead to longer waits for specialist appointments and care at emergency rooms.

The Eastern Shore currently has shortages in 18 of 30 physician specialties examined in the study, while southern counties have shortages in 25 and western counties shortages in 20 specialties. Physician reimbursements from insurers have fallen into the lowest 25 percent of rates nationally, according to the Maryland Health Care Commission.

‘‘Maryland is losing ground … and in regard to the nation as a whole, Maryland needs to get to the point of being more physician-friendly,â€? Fiedler said.

Miller said the CareFirst study combined data from the American Medical Association and the American Osteopathic Association. Lower reimbursement rates might be expected in states with many physicians, but ‘‘there is not a direct relationship but an observed relationship between more physicians and lower reimbursement rates,� he said.

Nailing down the correct numbers is an important first step ‘‘because we are trying to compare Maryland to our surrounding states, the states that we compete with for our physician supply,� said William Casey, CareFirst vice president of government affairs. ‘‘When the numbers that MedChi and [the hospital association] put out there looked very low to us, we asked Navigant to investigate.�

Meanwhile CareFirst is offering bigger reimbursements — up to 7 percent more — to physicians who meet standards developed by the National Committee for Quality Insurance, such as helping heart patients keep safe blood pressure levels.

Garagiola, who chairs a Senate health care subcommittee, said efficiency may be a key consideration.

‘‘If you factor that in [to the number of full-time physicians], the number will change,� he said. Garagiola expects a number of bills on the issue to be introduced this session but they will likely be aimed at passage next year.

This report originally appeared in The Business Gazette.
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