Bates sponsors Medicaid reimbursement hike

A bill proposed by State Sen. Alan Bates to give a big hike in Medicaid reimbursement to primary care doctors and nurses gets its first committee hearing today.

The bill aims to correct what Bates says is a basic problem in the health care system, the lack of primary-preventive care.

Senate Bill 210, sponsored solely by Bates, a Democrat, would require the Oregon Health Authority, which apportions federal Medicaid funds under the Oregon Health Plan, to give about a 66 percent raise to primary care doctors, either directly or through managed care organizations.

Bates is himself a primary care physician, but says he would not take the higher payments.

The bill says OHA shall reimburse primary doctors "on a fee-for-service basis at a rate equal to or greater than 150 percent of the Medicare reimbursement rate for the practitioners."

It was scheduled to be discussed today by the Senate Health Care Human Services and Rural Health Policy Committee.

"In all other countries of the world, 60 to 70 percent of physicians have their practice in primary and preventative care," Bates said. "Here it's the opposite. No one wants to go into primary and preventative care. Nurses are leaving to go in specialty care because that's where the money is."

The result, said Bates, is that doctors and patients aren't stopping as much illness early on, when it's cheaper and easier. Instead, people are getting chronic diseases, such as diabetes, high blood pressure and congestive heart failure, which require surgeries and other expensive procedures, all of which drive up costs of the health care system.

"This is not about making primary care physicians and nurses rich. It's about changing the system so health care costs come down," Bates said.

"Some specialists might at first say, 'Whoa.' They understand it will probably be money out of their pocket, maybe a 5 to 7 percent pay cut," said Bates. But, he predicted, they know there is a need for primary care and will ultimately support it.

Doug Barber, a lobbyist for the Oregon Academy of Family Physicians, an organization of primary care doctors, said his group will testify on the need for enhanced reimbursement ... but with "strong reservations," because the bill seems to "build on the fee-for-service system they believe is broken."

The OAFP, he said, would like to tie reimbursement increases to changes in primary care delivery.

Bates, a primary care physician in Medford for 30 years, said it might appear he, as the bill's sponsor, would have a conflict of interest, but he would specifically exempt himself from its increased benefits.

"I love my 30 years of practice as a family physician," said Bates, "but on a financial basis, it wasn't one of my smartest moves."

The bill is short, fewer than 500 words. If it moves forward, it is likely to be amended from many sides, said Bates, adding that he expects the input and support of Gov. John Kitzhaber, a physician.

State Sen. Jason Atkinson, R-Central Point, said, "In general, I'm very supportive of it, depending on how it comes out of committee."

John Darling is a freelance writer living in Ashland. E-mail him at

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