May 22, 2024
Doctors Making a Difference: Andrea Kalus, MD
Andrea Kalus, MD, a dermatologist practicing at UW Medicine, is working to make specialty care more accessible to all Washington patients, in the short term through volunteering with the Seattle King County Clinic, which provides free medical care to anyone who needs it, and long term by advocating for an increase in Medicaid rates in Washington (earlier this year, she participated in a WSMA media briefing on raising Medicaid reimbursements). She talks with WSMA Reports about why specialty care is essential care, and why raising Medicaid rates is a key component of ensuring patients get the specialty care they need.
WSMA Reports: There is sometimes a misconception that specialty care isn't as "essential" as primary care. As a dermatologist, why do you see specialty care as essential care?
Dr. Kalus: Before going into dermatology, I trained in internal medicine and practiced in a primary care clinic for a short period of time. Primary care is so important for patients and physicians in primary care can manage a wide and deep number of diagnoses. But when the diagnosis is not clear, or a procedure like a biopsy is needed for diagnosis, or the condition doesn't respond to the usual treatments, patients need access to specialists.
Seeing a dermatologist is not simply a luxury. It means having your psoriasis finally get better, treating a blistering skin disease, controlling eczema so a child can sleep and focus on school instead of itching, determining what allergens a hair stylist is reacting to so they can work, and managing autoimmune diseases like lupus to decrease permanent scarring and hair loss. In my experience as a primary care physician, I knew what I could manage and what I needed help with. I really valued the input from specialists when my patients needed it.
How is raising Medicaid rates an essential component of making specialty care more accessible?
Studies show Medicaid rates are a factor that determines access, and addressing this disparity is an issue of equity. Our state has one of the lowest reimbursement rates in our nation! The current reimbursement doesn't cover the cost of care. It's important to understand-this isn't about physician salaries, it's about covering the cost of staff like MAs and RNs, rent, and materials needed for the visit. When these costs are not covered, physicians limit or stop taking patients with Medicaid.
This has an echoing impact on the health of people in our state. Our patients can't find care, their condition worsens, it impacts employment; on and on the echo goes. Sadly, the echo eventually fades away and these patients are forgotten.
At UW, where I practice, we still take Medicaid insurance and I have patients who are forced to travel across the state to get care. Wait times for dermatology are way up because people have to queue to get care in the few places that still take Medicaid.
Have you faced barriers in your own practice in terms of having to limit Medicaid patients?
Our practice would not be sustainable if we only saw patients with Medicaid since it doesn't cover the cost of care. We have to balance numbers of patients with private and public insurance because the reality is the reimbursement from patients with private insurance is covering the gap in reimbursement for patients with Medicaid. As more and more dermatology practices in our state stop accepting patients with Medicaid, our wait times go up. For physicians, this adds to moral distress when we know we have the skill to help but we can't see patients who need us either because Medicaid doesn't cover the cost of care or the list of patients waiting is insurmountable.
What did your volunteer experience with the Seattle King County Clinic tell you about needing to make specialty care more accessible?
The Seattle King County Clinic is a wonderful project of the Seattle Center Foundation that hosts a four-day clinic each year offering free medical, dental, and vision care. Many of the patients we see have jobs and some insurance but high deductibles, high copays, or lack of access to physicians who will accept their insurance.
My work at the free clinic feeds my drive to advocate for better approaches that support patients in our state to get the care they need. The work of the clinic highlights the gaps we have in our state. I hope as the years go by fewer and fewer patients come see us at the SKCC because they can get care when they need it.
This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.