Rhode Islanders with Medicaid coverage may have a more difficult time finding a doctor. And every obstetrics and gynecology practice in the state has a waiting list. Those are just two of the findings in a massive survey just completed by the state’s health department.
On this week's The Pulse, Kristin Gourlay joins news director Elisabeth Harrison to share a few more highlights from the most comprehensive inventory of state health care resources in decades.
Want know whether we have the health care infrastructure we need to care for a changing population? Take a deeper dive into the Dept. of Health's most comprehensive statewide inventory of health care services, facilities, and providers since the 1980s.
Here's a transcript of the conversation:
EH: Kristin, this report from the health department is more than just an inventory of every doctor, hospital and clinic. It’s a snapshot of how patients are using health care and how health care providers are operating.
KG: Yes. It’s a really interesting collection of data about who has access to health care, who’s providing it, and how. And there are some important stories in this data with implications for lots of Rhode Islanders. First, a little background. Last year, the General Assembly passed a law requiring the health department to conduct this inventory. It’s the first time they’ve done this since the 1980s. And it was quite a process to get all this data. The health department sent out twelve unique surveys to every doctors’ office, hospital, behavioral health clinics...the list goes on. One major finding: it turns out we have a lot fewer primary care doctors– maybe up to 40 percent fewer – than previously thought.
EH: And why is that so significant?
KG: Because Rhode Island – through the efforts of the governor’s reinvent Medicaid initiative and lots of other projects - is trying to transform health care to be more patient centered, less expensive, and better at keeping us healthy. A big part of the plan relies on primary care doctors as kind of the front line, the health care providers who see us regularly, get to know us, and can spot chronic diseases and help you manage them before they become debilitating and expensive. We have the equivalent of about 600 full time primary care doctors. We probably need about 10% more to really reach everyone.
EH: Kristin, you found there’s another problem with access to primary care doctors: many of them aren’t taking new patients. And of those who are, quite a few aren’t accepting new patients with Medicaid. What is your sense of why that is?
KG: The survey didn’t ask health care providers why. But I suspect one reason is how much Medicaid, compared to other health insurers, pays doctors. But Elisabeth, it’s not just primary care doctors. Most psychiatrists reported they aren’t taking any new Medicaid patients, and only a tiny fraction of their current patients are on Medicaid. In fact, lots of psychiatrists seem to take no insurance at all, which means you have to pay out of pocket. There are alternatives: community mental health clinics. But they don’t always have enough psychiatrists on staff to meet the need.
EH: So, Kristin Gourlay, you’re talking about an access problem. Is it a problem across other specialties or providers?
KG: The survey found that every single obstetrics and gynecology practice – that’s women’s health – in the state has a waiting list for new patients. I’m not sure what it’s like for current patients, but that’s pretty significant. For other types of doctors, it seems to be a different story. For some specialties like nephrology—that’s kidneys – there’s no waiting list. And speaking of specialties, Rhode Island happens to have a ton of hematology/oncology specialists – that’s blood cancers – and cardiologists. I found that interesting.
EH: Let’s take a look now at hospitals. Kristin what does the survey suggest about how they’re being used and who they’re treating?
KG: Hospitals reported a pretty broad mix of patients in terms of the type of insurance they have. But what I found more interesting is the data about patient volume. We’ve known for a while that inpatient admissions are going down, and now we know how much. Over the past five years, they’ve declined by about 5,000 admissions. Inpatient admissions make hospitals a lot of money, but they’re being rewarded more and more for keeping patients healthier and out of the hospital. Losing that revenue source is one reason we’re seeing hospital systems seeking partners, offering new outpatient services. Interestingly, hospital births are up by nearly 1,000 in the past couple of years.
EH: Kristin, you mentioned this data covers every imaginable health care service and provider. Beyond doctors and hospitals, what caught your eye?
KG: Here’s one thing: did you know Rhode Island’s Department of Corrections is the single largest provider of psychiatric treatment in the state? Also, we have a 15 dialysis centers, but most of them are in Providence, so if you need dialysis and you live in Exeter or Little Compton, you have to travel.
Elisabeth, there’s another group of findings I want to share with you that suggests we don’t have the infrastructure we need to take care of our elders. Remember I said the state is trying to “reinvent” Medicaid? That includes lowering what it costs to take care of seniors who have both Medicare and Medicaid. The goal has been to get more people out of nursing homes, which is an expensive form of care, and into the community or assisted living. But the survey found most assisted living facilities are not accepting new Medicaid patients. And Medicare doesn’t pay for long term care.
What’s more, out of the state’s 90 nursing homes, most don’t have a special unit for patients with Alzheimers or other forms of dementia. That doesn’t mean they can’t do a good job taking care of them, but some patients need to be on a special, secure unit so they don’t wander off.
EH: And that’s huge because Rhode Island has one of the highest percentages of older people, and the rate of Alzheimer's is definitely going up here.