CMA Calls For Cutting Waste From Medi-Cal, Using Savings To Fund Health Care For Children

Main Category: Pediatrics / Children's Health
Article Date: 28 May 2009 - 4:00 PST

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The California Medical Association praised state lawmakers for ordering an audit of Medi-Cal's costly Treatment Authorization Request (TAR) process today and said the state should streamline the program and use the savings to pay for health care for children.

The Joint Legislative Audit Committee voted 9-0 to authorize the audit, as requested by Assemblymen Ted Lieu, D-Torrance, and Jim Beall, D-San Jose, and advocated by CMA. State Auditor Elaine Howle said it would take four months to complete.

The TAR process runs the state as much as $1.5 billion a year to administer, by some estimates, and creates considerable paperwork for physicians serving Medi-Cal patients. According to a 2001 California HealthCare Foundation report, few TARs are rejected. Therefore, the process does nothing more than delay treatment and increase administrative costs for more than nine out of 10 cases.

"The current TAR process is a lose, lose, lose proposition for the state, the physician providers and the patients," Dr. Ted Mazer told the legislative committee. Mazer is a San Diego ear, nose and throat specialist who is a member of the CMA Board of Trustees. "It is cumbersome, wasteful of financial and personnel resources, inefficient and off-putting to physician participation."

Like many doctors, Dr. Mazer has quit taking Medi-Cal patients because of the burden posed by bureaucratic requirements and poor funding. The result of low doctor participation is reduced access to health care for California's poor.

"At a cost of over $1 billion - enough to fund the Healthy Families program and prevent Medi-Cal cuts proposed by the governor - the TAR program eats up a lot of state money for no apparent value," Mazer said. "It's time to do a cost-benefit analysis of this program and devote the money to something worthwhile, such as health care for children."

Gov. Arnold Schwarzenegger has proposed eliminating the Healthy Families program, which delivers health care to 900,000 children from low-income families, to save $247.8 million in state spending. The reduction makes little sense, as the state receives $2 in federal funding for every $1 spent by the state on the program.

Over the last five years, the TAR process has been a target for review; however, changes have yet to materialize. The need to change the TAR system was recognized by a 2003 Medi-Cal Policy Institute report and in the 2005 California Performance Review. Both stated that the process was slow, inefficient, inconsistent and outdated.

Source
California Medical Association