In 1 Vermont county, disgruntled pediatricians leaving

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MONTPELIER — Northwestern Vermont's rural Franklin County had 11 pediatricians at the start of 2015 and will end the year with seven, a fact some doctors are blaming on low payments from Medicaid.

"I often thought I would work here until retirement; I love my patients and enjoy working with my colleagues," said Dr. John DiMichele, who announced this month he is leaving for North Carolina in January. "But the cuts to Medicaid this year have made it impossible to continue practicing."

Low Medicaid rates are a chronic complaint from health care providers, but they're more of a challenge for pediatricians in Vermont, whose patient base comprises children.

Vermont Medicaid includes an expansive children's health program called Dr. Dynasaur, which has largely succeeded in its long-held goal of providing health coverage to every resident under 19 who doesn't get it through a parent's private insurance. More than half of Franklin County's children and teens are covered by Dr. Dynasaur, state officials say.

DiMichele said he saw a 40 percent cut in his own salary this year.

"It is not reasonable that Medicaid reimbursement rates pay less than what the service costs us to provide and less than what Medicare pays for identical codes and identical work," he said.

Mousetrap Pediatrics, DiMichele's St. Albans practice, is short two physicians, with difficulty in recruiting tied to what state officials, including Gov. Peter Shumlin, have acknowledged are too-low payments from Medicaid.

Shumlin last January asked lawmakers for a new 0.7 percent payroll tax, which would have raised an estimated $90 million in state funds and drawn down an additional $99 million to strengthen Medicaid, said Lawrence Miller, a top health care aide to Shumlin. Lawmakers shelved the plan.

Medicaid reimbursements to primary care doctors were boosted by 20 percent under the federal Affordable Care Act, with the proviso that states would step in to cover that increase in funding beginning this year. That didn't happen in Vermont.

Miller said the loss of pediatricians in Franklin County "does speak to the need for the Legislature to address Medicaid funding."

An area with Franklin County's population, about 48,000, should have at least 10 pediatricians, said Dr. Laura Bellstrom, one of the departing pediatricians.

Dr. Barbara Frankowski, president of American Academy of Pediatrics' Vermont chapter and a pediatrician at the University of Vermont Medical Center, said of the Medicaid cuts: "In my 30 years in health care, I don't ever recall as big of a threat to access to care, and really the entire health care system, as this."

Bellstrom said she was closing her office not because of the Medicaid cuts, but because she felt the need to take a sabbatical. She worries, though, that low reimbursements will make it difficult to recruit replacements for her and others who are departing.

Bellstrom's decision is uprooting the other physician in the office, Dr. Kristen Connolly, who is moving 13 miles south to another pediatric office in Milton and is hoping to keep some of her current patients.

Connolly wrote recently to the Green Mountain Care Board, a state regulatory body, that "many of Vermont's pediatricians are nearing retirement age, and the odds of being able to recruit and retain young physicians with massive educational debt to primary care, especially in rural settings where Medicaid insures the majority of children, seem insurmountable in the current climate."

Miller said the administration would be happy to talk with legislators, who return in January for the second year of their biennium, about the need for greater Medicaid funding. But he said he did not hold high hopes for a tax increase in an election year.


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