By Andy Miller
Kids come from nine counties to receive care at Vidalia Pediatric Clinic. Nearly all have government health insurance through Medicaid or PeachCare.
The practice has lost money for the past three years. And if the upcoming state budget contains a 6 percent Medicaid payment cut to doctors, as proposed, the pediatric clinic could be sent to the financial brink.

The pay cut is among the difficult options that the Georgia General Assembly is weighing to fill a financial hole in the Medicaid program, which covers more than 1 million poor and disabled Georgians. Solving the Medicaid problem is a wild card as the legislative session nears its end.
Across Georgia, medical professionals are calculating potential damage if cuts are approved. “Devastating” is a word commonly used.

“You can’t take care of the kids if you can’t keep the doors open,” says Sam Oates, a nurse practitioner at Vidalia Pediatric Clinic. If the clinic closed, Oates says, the poor would have to travel 45 miles to find a pediatrician who will see them —- or seek care in a hospital emergency room, an expensive option.

Major urban hospital systems such as Grady Health System and Children’s Healthcare of Atlanta report that Medicaid reimbursement decreases would cause a hit of $26 million and $30 million, respectively. Rural medical organizations such as the Vidalia clinic, meanwhile, are equally vulnerable, though on a smaller scale. And their patients are vulnerable as well, experts say.
Health care isn’t the only sector facing steep budget cuts, with a state revenue shortfall exceeding $2 billion. Most state agencies face cutbacks of at least 10 percent this year. As the economy has faltered, both Medicaid and PeachCare, for children in families with slightly higher incomes, have swelled in enrollment.
Bert Brantley, spokesman for Gov. Sonny Perdue, acknowledges the Medicaid funding decision is difficult. But he says if payment rates aren’t reduced, and if the Medicaid rolls increase as expected, “We’ll run out of Medicaid money” next year.

The health care balloon is being squeezed at a difficult time for the medical community, already rocked by the recession.
Many rural hospitals already have little financial wiggle room. “We’re in the middle of a lake, up to our necks,” says Earl Whiteley, CEO of Calhoun Memorial Hospital in Arlington. The hospital has lost money for five years. A 10 percent Medicaid cut for hospital care could force it to close, he says.
Dodge County Hospital in Eastman says it could lose $500,000 if the Medicaid cuts were enacted, plus another $150,000 in reductions to doctors that the hospital employs.
Meanwhile, rural doctors and dentists with a heavy load of Medicaid and PeachCare patients predict they’ll continue to be flooded by people seeking appointments. “I’m inundated,” says Darryl Chapman, a Cordele dentist. About three of every four of his patients are covered by Medicaid and PeachCare.
Payment cuts would cause some rural doctors to close their practice to new Medicaid patients, while others may leave rural Georgia altogether, says John Crew, a health care consultant based in Albany.

Brooklet family physician Scott Bohlke says a payment cut would force him, like other area doctors, to stop seeing new Medicaid patients. “They’d probably have to go to Savannah, 50 miles away,” Bohlke says.
Meanwhile, plant closings such as Pilgrim’s Pride in Douglas will drop more children onto the public programs, says Dushyant Patel, a longtime pediatrician in the South Georgia town. His Medicaid load is about 80 percent of his practice, and he usually draws the new patients with government coverage, he says.
Lower Medicaid payments would make recruiting a new doctor to a rural area, already difficult, that much harder, consultant Crew says. As older physicians retire, he says, “many communities run the risk of losing complete access to the care that they need.”