Changes mean less care, more profits: HMO Business in Florida

Is it getting any better anywhere? BD

Before reform, about 95 percent of Florida doctors participated in Medicaid. Now a survey conducted by Georgetown University indicates that more doctors are dropping out of Medicaid and those that remain are seeing fewer patients. Most doctors stay in the system only out of loyalty to their patients with whom they've enjoyed an established relationship. Feeling overwhelmed by the harrowing challenges of just complying with arcane regulations and realizing that reimbursements are inadequate, many doctors are simply quitting. And there is little likelihood that things will get better since payment to doctors is down while paperwork is up.

While doctors are being paid less, the 15 HMOs and networks are being paid more. Prior to reform, HMO profit was a staggering 18.6 percent. Despite this, the Florida legislature is planning to increase their payments 11.7 percent! The securities firms CIBC World Markets and Goldman-Sachs reported that WellCare -- a major Florida Medicaid HMO -- has been shifting money to the Cayman Islands in the form of reinsurance premiums. Goldman-Sachs spokesman Carl McDonald stated that "Florida appears to be overpaying its Medicaid plans, and it would seem to be only a matter of time before the state figures this out." Florida's stated objective was to improve both access and care while saving money. Medicaid reform has accomplished little except enriching privately-held HMOs.

Gone are the days when a doctor just provided care. The doctor has become an uncompensated agent for the HMO............