Medicaid Issues

My name is Dr. Raul Vazquez, MD. I am board certified in Family Practice and have been in private practice for 12 years. I provide care to a large Medicaid population on the Westside of Buffalo. In 2003 I relocated my office from 778 Niagara Street to 564 Niagara. I purchased a piece of land and built a "State of the Art"12,000 square foot medical facility. My facility employs over 25 people. Most of the employees are bi-lingual and live right in the community. We have diversified the office to learn from the population and the modalities in order to increase revenue. We perform office services like spirometries, ekgs, holters, arterial dopplers, stress testing, cryotherapy, hair removal and laser services. Extender operations include ophthalmology, x-ray, cardiology, surgery, podiatry, physical therapy, durable goods, and pain management; all private practice model.

Every year it is becoming more and more difficult to sustain due to the decreases in Managed Care reimbursement. Managed Care has in some instances cut fees up to 66%. Over the last 15 years, I have noticed an increase in premiums but a decrease in service. It would seem that by this time, outcomes would be improved. There should be better management of chronic diseases and a reduction of costs. However, the costs are being controlled by reducing reimbursement to providers. Managed Care is in the business of managing costs NOT managing care for patients. As a primary care physician, it is my responsibility to refer patients to the appropriate specialists. However, it is gravely difficult to find specialists that even accept my Medicaid Managed Care patients. Moreover, the providers that once accepted these patients are now declining them. It is simply insulting to expect providers to work for free. We have to provide malpractice and quality care to all of our patients, ill-respective of their medical insurance.

In this area the fees are so low that most providers are leaving, or in the process of leaving, which is what prompted this letter. Today Ophthalmologist, Dr. Rafael Medina, who has been in my facility for 5 years, told me that he would be leaving next month due to reimbursement decline. It is no longer feasible for him to manage this population.

I know that the county is concerned with the welfare of all its citizens; And you as a businessman can appreciate the struggles of another business entity. I have been able in the past 12 years to show improved outcomes on chronic diseases. Asthma, Diabetes and Hypertension is very prominent in this community, However, my asthmatic patients are admitted less than 1% with a 0% morbidity/mortality. My diabetics are controlled at an average HGA1C of <8. Nationally, diabetics are averaging HGA1c's of 9. My hypertensives, and my depressed patients are also well managed and improved. We receive no federal, state, county or city funding. I am simply asking the County and the State to look at the present problems. I do not want to abandon my patients; I feel that I am providing a necessary service. I have some suggestions for improving care and managing populations NOT solely managing costs.

I would be honored to sit down with the elected officials and brainstorm an alternative to the status quo. Insurance companies are concerned with patients accessing emergency rooms for routine care that could be performed by their primary care doctor at a fraction of the costs. Well, if current trends continue, more patients will be forced into the ER's due to a decline in the number of providers that will accept them. This type of segregation creates a cast system that I am sure New York State would not be proud of. Healthcare has become desensitized and patients with substandard coverage are being ostracized by the entire industry, including the pharmacies, the doctors, the extenders and the insurers.

Sincerely,

Dr. Raul Vazquez, MD, FAAFP