State to allow poor to choose their own doctors "MAC" program aims to cut costs and improve care.

December 10, 1991|By Sue Miller | Sue Miller,Evening Sun Staff

If a woman is poor, she no longer has to have sick babies or die prematurely of breast or cervical cancer because she gets no preventive care, said Nelson J. Sabatini, the state health secretary, in announcing the start of the new Maryland Access to Care program.

Sabatini yesterday hailed "MAC" -- a program that allows Medicaid patients to choose their own doctors -- as "a new day in the delivery of health care to the poor in Maryland, one that will make a significant difference."

MAC is intended to save the state $24 million during the next fiscal year by steering recipients of medical assistance away from costly emergency rooms. Many recipients seeking non-urgent care now use hospitals where treatment costs three times more than if provided in an office or clinic.

For at least the last 17 years, the state has been trying to find a way to persuade the poor to stop using emergency rooms as their "community doctor." But, the first time, MAC has established a huge network of providers that will manage the care of poor patients and has the potential for bringing about change.

MAC also will have a built-in monitoring system that will look into patient complaints, Sabatini said yesterday at MAC headquarters, 201 W. Preston St.

"Our interest is in seeing that people get quality care," he said.

The only other state that has a similar plan to cut escalating Medicaid costs while improving care is Kentucky, according to Sabatini, who described that program as "successful."

Already 60,000 of the state's medical-care recipients have voluntarily joined MAC, said Sabatini, who predicted that 75 percent of this population will be drawn into the program. Within the next seven months, he expects about 320,000 clients to be enrolled and that figure could increase, he said.

Under MAC, a client must choose a primary medical provider to give continuing rather than episodic care and refer patients to specialists if necessary. The primary provider can be a doctor, a nurse practitioner or a clinic.

A total of 1,500 health-care practitioners have agreed to take on this responsibility, while keeping patient records and delivering primary and preventive care on a 24-hour, seven-day-a-week, on-call basis.

More important, Sabatini expects strong doctor-patient relationships to develop so there will be at least a 10 percent increase in childhood immunizations and at least another 10 percent increase in the number of poor women who will have Pap smears and mammograms regularly.

Participating medical providers will receive an increase in fees. For an office visit, the fee for a MAC patient goes up to $32 from the standard $21 for Medicaid care.

Dr. Robert M. Heyssel, the president of Johns Hopkins Hospital, says he welcomes the MAC program as "a pro-active method of guiding primary care out of the emergency room and back to where it belongs -- with the physician."

"The primary-care clinics at the Hopkins Hospital, at the Francis Scott Key Medical Center and at the site of our Medical Service Corp. are all participating in this program," he said.

When new Medicaid clients sign up for MAC, they receive their new black and gold medical assistance cards, which promise "better care for them and their families." Each card will include the patient's name and address and the person's personal doctor's name and phone number.

Anyone new to the program has 30 days to select a primary provider. If the person fails to do so, the provider will be randomly chosen from an approved list.

Medicaid recipients will be phased into MAC over the next six months. Those who have not yet chosen a primary medical provider will have to choose when they are recertified for eligibility for medical assistance.

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