Councilors vow to address shortage of medical providers

Oct. 11--LAS CRUCES -- Las Cruces city councilors said Monday they plan to wade into a looming health care crisis affecting Doña Ana County: a shortage of doctors within fields ranging from primary care to neurology.

National guidelines indicate that the county is short "no less than 131 providers," said Phillip Rivera, president of Las Cruces Physician Practices, affiliated with Memorial Medical Center. Within that figure, the county is short 80 primary care, 16 psychiatry and 12 OBGYN doctors, among other categories, he told city councilors on Monday.

The situation is dire, Rivera said.

"To me, this about the long-term future of health care in our community," he said.

Also part of the problem is that the average age of doctors in the county -- 65 -- is higher than in other places, according to Rivera. While new doctors are initially attracted to the area because of several positive attributes, he said, they don't wind up staying after they realize the financial difficulty of practicing in Doña Ana County. Many new doctors leave medical school with debt ranging from $250,000 or more and must earn a certain income to repay those loans, he said.

Several factors are to blame for the situation. For starters, a high percentage of patients locally -- more than 40 percent -- have Medicaid. And the reimbursement rates to doctors for Medicaid claims saw no increases for eight years -- though costs of providing care continued to increase -- and also were cut on July 1. He said Medicaid payments rarely cover actual costs of care.

Secondly, Rivera said, the county is at a disadvantage compared to northern New Mexico cities when seeking reimbursement from insurers -- called managed care organizations -- for care provided to their clients. The hospital is not allowed by law to speak with other providers to find out what they're paid from the insurer. But Rivera said the hospital does get a glimpse of other rates because its own employees do receive medical care in other cities. And those records are showing that insurance companies are paying Las Cruces doctors "significantly" less than their peers in other cities, such as Albuquerque, for the same types of services being provided.

Additionally, Rivera highlighted several state laws that he said aren't being followed by insurers in all instances, which leads to lower payment to doctors. For example, he said, a statute requires insurers to pay gross receipts tax on claims it pays to physicians, but that's not always done.

"To me, there's a regulation on the books that isn't being followed" by MCOs, Rivera told city councilors.

Another state law provision imposes deadlines on insurers to credential new doctors as acceptable providers -- which allows the doctor to bill the insurance company for care provided. But MCOs at times drag their feet on such approvals, Rivera said.

The Sun-News left a message for the New Mexico Office of Superintendent of Insurance, responsible for enforcing provisions tied to health insurance, on Monday, but was not able to reach anyone at the office. Also, four MCOs in New Mexico could not be reached for comment by press time.

Las Cruces City Councilor Jack Eakman, a retired nonprofit hospital administrator, said the physician shortage is of critical concern to the well-being of residents. Reimbursement rates must be high enough to allow the city to compete with other places to recruit and retain physicians, but they're not, he said.

"Las Cruces and Doña Ana County are at a distinct disadvantage," he said at Monday's work session.

Debbi Moore, president and CEO of the Greater Las Cruces Chamber of Commerce, told Las Cruces city councilors that the problem is front and center on that organization's radar. She said the organization is willing to work with the city on solutions.

City Councilor Ceil Levatino, whose husband is a Las Cruces doctor, told Rivera he was spot-on in his portrayal of the state of medical care in the city. She said another aspect of the problem is the lengthy wait times to get an appointment with physicians, specialists in particular. That's causing some patients to seek care in other cities, she said.

City Councilor Olga Pedroza asked Rivera why providers haven't filed a lawsuit against the MCOs to seek enforcement of state laws. He said they'd prefer to work collaboratively before resorting to an adversarial stance. But he acknowledged the situation could wind up in a lawsuit, if circumstances don't improve.

Several city councilors expressed support for the city taking steps to counter the physician shortage. City Councilor Gill Sorg said the city will be discussing priorities it wants to push in the 2017 state Legislature.

"And I would like to see this put at the top of the list," he said.

Interim City Manager David Dollahon told councilors the item will appear on a future meeting agenda to become a city priority for the legislative session.

Doña Ana County Commissioner Billy Garrett told city councilors he's willing to throw his support behind councilors' effort to address the physician shortages. He suggested coordinating with other southern New Mexico counties because the problem is likely a regional one.

Two residents, one of whom is a registered nurse, told councilors they moved to Las Cruces because of a number of positive traits in the city. However, they realized that access to health care and specialists is lacking. They plan to go to the Mayo Clinic in Arizona for any serious needs and may move out of state if the local health care landscape doesn't improve.

Eakman asked that the city compile what's known as a "loss run" report, which shows the reimbursement paid to providers for medical claims filed by city government employees. Dollahon said city staff will compile that.

Rivera said he fields many requests from doctors who are looking to join the hospital because their own clinics are struggling.

"Every day that goes by, folks are running for cover, looking for how to save their practices," he said.

Diana Alba Soular may be reached at 575-541-5443, [email protected] or @AlbaSoular on Twitter.

___

(c)2016 the Las Cruces Sun-News (Las Cruces, N.M.)

Visit the Las Cruces Sun-News (Las Cruces, N.M.) at www.lcsun-news.com

Distributed by Tribune Content Agency, LLC.