The Maine Department of Health and Human Services’ proposed $20 million Medicaid rate cut to hospital-based physicians, part of the governor’s supplemental budget, is a shortsighted solution with negative long-term implications. If approved, it will diminish access to health care, increase the cost of health care in Maine and make it even more difficult to recruit doctors to a state already struggling with a shortage of physicians.

About 270,000 Mainers are on Medicaid and hospital-based physicians offices are a large source of their health care. Access to this primary care is the least expensive and most effective way to fight the chronic diseases that are the leading causes of serious health problems in Maine.

The Medicaid payment fiasco intensified the impact of insufficient reimbursement paid by Medicaid to private practice physicians for the treatment of Medicaid patients. This caused many private practice doctors in Maine to limit the number of Medicaid patients they treat on a daily basis. In 2004, Maine hospitals agreed, in exchange for a more reasonable payment rate, to a compromise with the state in which their hospital-based physicians would not limit treatment of Medicaid patients. These are the dollars under discussion.

I view the health care environment in Maine from several vantage points. As a medical staff officer, I have witnessed firsthand the positive impact that the increased access to primary care provides to Maine communities, and I understand how the loss of reimbursement will negatively impact hospitals in Maine. Philosophically, it is wrong for the state to renege on its 2004 agreement with hospitals, and now mandate unrestricted treatment but with reduced and unsustainable reimbursement levels.

As president of the Maine Medical Association, my viewpoint focuses upon how these changes would affect quality and increase cost of health care in our state. Diminished access to care will result in delay of treatment, intensification of illness and a shift of care to emergency rooms and other more expensive types of services. Low reimbursement is a large part of the struggle Maine physicians have faced as they seek to survive in private practice settings, and private practice physicians who choose to stay in Maine will often join a hospital-based practice. Currently, Maine’s hospitals employ 41 percent of all physicians in the state, but this avenue will also be threatened if this proposal passes.

Fiscally, the proposal makes little sense as the savings are not what they appear to be. The two for one federal match for state Medicaid funds means that Maine is losing $14 million in federal funds, or $2 lost for every $1 we try to save. In other words, the state is saving $7 million, but we are losing $14 million in federal monies, and hospitals in Maine would lose $20 million in reimbursement for health care.

Finally, as a physician treating patients in Maine for 20 years, I have experienced firsthand the difficulties access to health care present to patient care in our state. Recruiting and retaining talented physicians is already an issue, and currently there are 200 physician vacancies in the state, 50 percent of which are for primary care. A shortage of doctors means diminished access to care for patients, and also impacts medical treatment as we care for our patients. Physicians in Maine already experience difficulties finding colleagues to help care for their patients when needed, and this proposal would intensify the problem.

The proposed rate cut might reduce the state’s short-term financial challenges, but I ask our legislators to take a longer-range view.

Philosophically, hospitals made a good faith compromise with the state, and the state must not renege on its agreement. Fiscally, the proposal is unsound, and will cost hospitals $20 million, while only saving $7 million for the state. In the future, acceptance of this proposal will ultimately reduce access to primary care, increase the cost of care and increase the effects of chronic disease. These are outcomes no one wants.

A public hearing on this proposal is scheduled for 9 a.m. Feb. 8. I urge you to contact members of the Joint Standing Committee on Appropriations and Financial Affairs, the Joint Standing Committee on Health and Human Services and your local legislators before Feb. 8 and let them know that reducing the Medicaid reimbursement to hospital-based physicians is bad medicine for Maine.

William Strassberg, M.D., an orthopedic surgeon, is the president of the Maine Medical Association, vice president of Mount Desert Island Hospital’s medical staff and a staff member of MDI Orthopedics.