Dean's Message

Donald E. Wilson, MD, MACP, The John Z. and Akiko K. Bowers Distinguished Professor and Dean

As physicians, our primary responsibility is to provide care to those who need it. As teaching physicians, we are responsible for educating future physicians and scientists. But there are forces at play that seriously undermine both of these missions. Access to medical services for some Maryland residents receiving medical assistance is being jeopardized by inadequate physician reimbursement. As a result, our financial stability and education programs are in danger.

Maryland faculty provide primary and specialty care to over 100,000 West Baltimore residents. Many of these patients are uninsured or are covered by the Medical Assistance Program. For the uninsured, most of the care is free, while Medical Assistance payments cover less than 50 percent of the cost of care. This is particularly burdensome because our clinical practice plan is supported entirely by revenue generated by clinical collections. Clinical services, which are essential to our patients and to the educational programs of the medical school, are in need of increased support.

During the last legislative session, state government took the first step to address this problem by increasing some fees, primarily those related to cognitive and critical care services. This increase was the first in ten years and is supposed to be the first in a multi-year plan to bring Medical Assistance fees in line with Medicare (which itself is becoming problematic in terms of the level of reimbursement).

Even after adjusting for the annual benefit of the fee increase, the faculty practice plan will incur a loss of approximately $9 million on services to Medical Assistance patients, and annual losses of $8 to $9 million on services to uninsured patients this year. In the past, care for Medical Assistance and uninsured patients has been indirectly subsidized by the commercial payers via the School of Medicine Medical Service Plan. Over the past five years, however, commercial payers have reduced reimbursement levels to the point where subsidies are no longer possible. Unlike other Maryland hospitals, we do not have an all-payers system for physicians who provide care. Physicians must accept what a payer offers or decline to provide care for patients in the program.

Thus, we are caught between a rock and a hard place. While we are the principal provider safety net for patients in West Baltimore, and we see and treat all patients who walk through our doors, over 28 percent of the total services we provide are reimbursed at less than 50 percent of our cost to deliver the service. This cannot continue.

Physician reimbursement for our Maryland patients must be increased. Last year the state legislature, recognizing the serious consequences to the educational programs of the school of medicine, took the extraordinary step of providing a one-time $3 million grant directly to the medical school to offset the Medical Assistance losses and enable the school to retain core faculty. It is imperative, however, that we find permanent additional funding for the medical school clinical education programs to ensure that our teaching programs remain viable, and to ensure that we can continue to provide the citizens of Maryland with the quality care that they need and deserve.