On most occasions, Burtt Richardson would be reluctant to add the word “prophet” to his professional resume.
Yet, secretly, the Winthrop pediatrician hopes his plan to improve health care access for Maine’s 36,000 poor children will become a catalyst for future change in the delivery of medical services.
A soft-spoken man who has practiced in the Augusta area for 20 years, Dr. Richardson received a round of applause Thursday at the State House from child care advocates attending a press conference for the Maine Children’s Alliance. The organization’s Maine Kids Count effort had just released its 1998 data book, a clearing house of information on the overall health status of Maine children.
As a member of the alliance’s Maine Kids Count Committee, Dr. Richardson was disappointed, but not surprised to learn, that 11.7 percent of all Maine children lacked health insurance between 1992 and 1996. The conclusions from that statistic are equally discouraging. No insurance generally translates into reduced preventative health care and greater reliance on Maine’s hospital emergency rooms for routine assessments that could handled more appropriately — and inexpensively — in a pediatrician’s office.
In fact, the 1998 Maine Kids Count data book concludes that 36,000 visits by children to hospital emergency rooms in 1994 stemmed from illnesses that could have been better treated in a physician’s office.
So why aren’t poor families covered under Medicaid seeing private physicians when their children come down with ear aches and influenza. For some, there is the perception that a trip to the emergency room will yield quicker results. But for many others, the problem is a lack of pediatricians willing to accept Medicaid payment rates for services rendered.
Exuding a more seer-like aura, Dr. Richardson predicts closing the doors to Medicaid pediatric patients is a practice that must change. And if there are 100 pediatric and family practitioners currently licensed in the state and there are 36,000 unnecessary trips to the ER, Dr. Richardson figures it just comes down to a case of doing the math.
“It would take only one additional visit per day by the pediatrician’s office for one of these physicians to prevent every one of those ER visits,” he said. “We do have to encourage our colleagues in pediatrics and family practice to open their offices to that one extra patient each day to absorb those children who currently going to the emergency room unnecessarily.”
And with a high price tag to boot. Dr. Richardson said the more expensive emergency room visits cost Medicaid about $3 million annually. Hospital emergency rooms are also not the most appropriate for routine pediatric care, Dr. Richardson said, emphasizing that ER physicians usually don’t know their patients and are geared more toward handling the crisis of the minute. Additionally, diverting attention to a child who could have been seen by a pediatrician during an office visit only heightens the level of anxiety in most of the state’s pushed-to-the-max emergency rooms.
Dr. Richardson knows there are some pediatricians who are reticent to accept and even refuse Medicaid clients because the insurance pays only a third of he actual cost of the patient’s care. He also knows the demands of a private practice and understands Medicaid reimbursement barely covers the costs of office overhead. Still, he maintains resolving a far-reaching problem like children’s health care at the point of origin is preferable to a lengthy bureaucratic solution at the state or federal level.
“It’s a first step toward changing policy and it would take a minor policy change at the physician’s office level if just one Medicaid patient per day reduced all of that expensive care for what could be less expensively served in the physician’s office,” he said.
A. Jay Higgins is the NEWS political editor and can be reached at State House Station 50, Augusta 04333 or e-mailed at Domecity@aol.com.