Viewpoints: Lack of doctors in Humboldt reflects rural problems with access to health care

This article originally appeared in the Sacramento Bee

Humboldt County is a place of stunning physical beauty, a stark contrast to its residents’ astoundingly poor physical health. State data show the county at or near the bottom of health/wellness measures in virtually every category.

Now comes a different knock to the county’s health, one that could reflect trouble for health reform in rural California.

After fielding complaints from patients, physicians and brokers, the county’s medical society set out this summer to find out how many doctors listed by its largest Covered California-offered plan actually participated in it. Covered California, of course, is the Affordable Care Act’shealth insurance marketplace.

The medical society found that of the 109 primary care physicians listed in the Anthem Blue Cross Pathway plan directory, fewer than 34 percent were participating and accepting new patients. Put another way, two-thirds of Anthem Pathway’s listed doctors did not participate in the Covered California-offered plan.

The takeaway by Humboldt-Del Norte County Medical Society executive director Penny Figas: “The patients don’t have access.”

Humboldt is one of 22 rural Northern California counties to make up Covered California’s pricing Region 1. Anthem has signed up 91 percent of the region’s 49,665 enrollees. If Humboldt’s profile resembles its rural brethren, of its 5,679 enrollees, more than 5,000 will have a lot of trouble finding a physician to see them.

Without question, access is a major issue facing Obamacare’s implementation in California. What good is it to sign up for and pay for health insurance if you can’t find a doctor to see you?

Take a closer look at the Humboldt County list and it becomes what is surely a bad joke. According to the Medical Society’s survey, 13 doctors don’t practice at the address listed by the plan; for nine others, the office location is simply closed. Another five are no longer in the area, while seven others are retired. Meanwhile, the survey found duplicate entries in six cases. In nine cases, the physician does not practice primary care, in eight cases the doctors are substitutes – meaning only temporary and from outside the region. And in six cases the physicians work in an administrative capacity – they don’t see patients.

Anthem Blue Cross spokesperson Darrel Ng says that while rural residents have “every right that we fulfill the guidelines for adequate networks and timely access,” they also have to realize that their choice to live in a rural area “means they’ll have fewer services to choose from, and along with that fewer providers.”

And the duplications in the provider list?

Ng says the plan’s doctors “are contractually required to notify Blue Cross when they move, when they retire or otherwise leave the network. Any change is generated by action by the members, not the plan.”

The facts on the ground, Figas says, have left her county’s medical world a mess. “The physicians’ heads are spinning. They don’t know what list they’re on and not on.”

Ng says Anthem is working to fix that list.

“In the last several months, Anthem has conducted a campaign to every provider in Region 1 to ensure the accuracy of our listings … We would have called every doctor listed in our Pathway coverage in Humboldt County to make sure they agreed with what our records reflect.”

It doesn’t end there, Figas said. Even when you eliminate the duplications, retirements, wrong addresses and wrong specialty, even when you’ve got the list pared down, a doctor might have reached her or his patient limit.

“Just because the names are on the list, that doesn’t mean they’re taking new patients,” Figas said.

This lack of doctors attached to the Covered California Anthem plan, she said, leaves those physicians who are seeing new patients overwhelmed. Nerves are frayed.

In Humboldt County, where by her count a majority of doctors are over 60, “This is going to push them over into retirement.” And as the county loses its older doctors and struggles to replace them, “It’s up to the ones still here to absorb the load. It disrupts the community.”

The retirement of older physicians and recruiting new ones have for decades been a problem for rural California. The question is, can the Affordable Care Act change that trend? Can Obamacare and providers like Anthem provide improved access to care in these faraway places?

Maybe the question should be: Is there any system that can?

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