The former chairman of the District of Columbia's Health Planning Advisory Committee says she will not treat Medicaid patients in her private pediatric practice after June 1 because the city's Medicaid program requires her to provide inferior care to her Medicaid patients.
In a letter to Albert P. Russon, director of the city's Department of Human Resources, Dr. Bette Catoe charged that the program, which pays for health care for the indigent "condone(s) and encourage(s) two levels of medical care for the citizens of the District of Columbia."
Catoe said that because Medicaid does not pay for certain types of visits, and only pays for certain numbers of others, she is forced to stop to consider whether or not a patient is on Medicaid. She said she treats all her patients equally, but cannot continue to do so and adhere to both old and new Medicaid regulations.
Catoe said that Medicail regulations instituted within the past year require that a pediatrician not see a child more than once in a month for the same illness.
A child might have a throat infection on the first and 20th of a given month, she explained, "but you could not see the patient and use the same (Medicaid computer) code. We were trying to find another code to use and this bothered us all to hell.
"You just don't go to medical school for this. You go to medical school to learn to practice medicine," said Catoe, a graduate of Howard University Medical School who has been practicing medicine in Washington for 22 years and is now into her second generation of patients.
Peter Coppola, chief of the city's Medicaid program, said Dr. Catoe's interpretation of the rules on the number of visits for the same condition is "a complete misunderstanding."
Coppola, who said Russo did not send him a copy of the April 5 letter until April 26, still has not completed the city's response to Catoe. He said all Meidicaid physicians in the city were informed last year that the city was running a computer check to see if any bills had been submitted within the past two years for identical services to one patient twice or more on the same day.
Coppola said that he "got complaints from individual physicians but I didn't think it was widespread.
Catoe said that she and her partner Dr. Lillian M. Beard, who also signed the letter to Russo, see 25 to 50 patients a day, 30 to 40 percent of whom are on Medicaid.
Asked yesterday about the April 5 letter from the two pediatricians, Russo said "We've got the letter under careful consideration. I have directed the Office of State Agency Affairs (which has jurisdiction over the Medicaid program) to analyse the letter and to submit a report to me responding to each of the statements.
"I feel it's unfortunate that Dr. Catoe is planning to suspend participation in the Medicaid program because Dr. Catoe provides valuable services to Medicaid patients," said Russo. Russo could not say when the analysis would be completed, and a reporter's telephone calls to Jackie Johnson, chief of the Office of State Agency Affairs, were not returned.
Following a strike by the city's independent pharmacies, Russo announced in March that he was recommending the first increase in Medicaid payments to physicians and pharmacists since 1968.
But according to Catoe, some payments to primary care physicians such as pediatrician have been cut.
Before March, a physician was paid $28 for a "new patient visit," said Catoe which includes "a omplete physical, history, consultation and urinalysis. We'd include some counseling, telling them how we practice medicine, explaining that they have to call us, keep their appointments, the whole orientation. It takes about 45 minutes to an hour and a half" of physician and staff time.
The new Medicaid payment schedule provides $20 for such a visit, she said.
Coppola said the new fee schedule may have cut back on the payments received by some physicians. "It was our intent to make the program a little easier to administer by averaging out the fees to each physician," he said. "Rather than pay them six or seven different types of fees for six or seven services, we settled on an average fee for certain basic types of office visits.
"For some pediatricians it would be an increase, for some it might not be a change and for some it might be a decrease," said Coppola, who said that neither the change in the fee schedule nor the new computer coding was intended to reduce services.
"We're feeling very bad about the whole thing," said Catoe. "We've thought about this and did not want to do it, but it's very difficult to give the kind of care we want and go through the bureaucratic mess.
"Some of our patients have been told we'll just treat them and that's that. We did it before Medicaid and we'll do it after."
In a "Dear Parents" letter Catoe and Beard explained that "this step has been taken only after long hours of contemplation, soul searching and accounting analysis. The Department of Human resources, through its methods of reimbursment, rule making and management, is forcing two levels of care - meaning an inferior level of care for Medicaid patients in relationship to self-pay or private insurance patients.
"It is a great moral and intellectual strain on your physician to be forced to give one level of care to your child, as a Medicaid recipient, and another level to non-Medicaid patients. This is not fair to you and very disruptive to the physician dedicated to quality medical care."