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When Shani Muhammad, MD, meets with her patients, they often talk about more than health.

As an urgent care physician in San Jose, most of Dr. Muhammad’s patients are Medi-Cal recipients or uninsured. And one common refrain is the difficulty they have accessing healthcare, making appointments — and even interacting with other providers.

“They don’t feel like the physicians are working as hard to figure out what’s going on with them, or listen to or understand them,” she said. “I had patients complain, generally, of feeling discriminated against, or treated like their intelligence level wasn’t as high, or of not having things explained to them because of the assumption that they won’t care.”

“A lot of times they express the statement, ‘They didn’t get me,’ ‘They didn’t try to get me,’ ‘They were judging me,’ or ‘They were making assumptions about me,’” she said.

Dr. Muhammad’s patients are not alone.

Data released in June by California’s Department of Health Care Services show that nearly 7,000 Medi-Cal patients filed official grievances about “poor provider/staff attitude” in the last three months of 2017, the most recent data available, making it the top quality-of-care complaint. Anthony Cava, a spokesperson for the healthcare agency, said that because this grievance category is new, the department can’t yet assess which direction this dissatisfaction is trending.

But advocates say that issues of stigma, cultural competence and language barriers have long been problems for Medi-Cal patients in their interactions with providers.

“We know that there’s an alarming number of consumers who have had poor experiences with care,” said Kimberly Chen, government affairs manager for the California Pan-Ethnic Health Network. “And what you get when you have providers who don’t approach patients with cultural humility is you prescribe incorrect treatment, undertreatment or overtreatment, and then ultimately people’s health suffers.”

When the California Black Health Network recently embarked on a seven-city listening tour to better understand the needs of black patients across the state, one common complaint was the stigma of Medi-Cal, said the group’s deputy director Angelo Williams.

“‘The issue is, I’ll use the card, but I’m treated in a different way because I’m using the card,’” he recalled people saying. “The stigma is that in using the card, it reinforces some of the external stereotypes, the imposition of an inferior status.”

One consequence of this, Williams said, is that many African-Americans who are eligible for Medi-Cal aren’t using it for fear of how they’ll be treated in the doctor’s office.

And for those Medi-Cal patients who do seek out care, there can be stigma in not already being in good health, said Chen. She’s seen this particularly at the dentist.

“Older folks with dental needs are going to certain providers who may have unfair attitudes towards them,” she said. “Because they haven’t had the opportunity to have dental care, their teeth might be in poor condition and they feel shamed by it. They say, ‘I know, I didn’t have the care, I’m trying to do the right thing, I’m trying to get some cosmetic things fixed so I can get a better job,’ but they have these judgmental feelings.”

Language can also be a problem.

Rocio Gonzalez, health policy advocate for the Mixteco Indigena Community Organizing Project (MICOP), which serves the indigenous immigrant community in Ventura County, said that many of the monolingual Medi-Cal families she works with have trouble making and getting to appointments, and navigating the healthcare system in general.

When they do engage with providers, language and cultural barriers can put families at even greater risk than just poor care. One new mother, said Gonzalez, scheduled a doctor’s visit for her baby, but on the day of the appointment, was unable to get there because the transportation service MICOP had arranged didn’t show up.

“Child Services ended up getting involved because they thought Mom was being negligent,” said Gonzalez. “But that wasn’t the case at all.”

In the past year, MICOP has partnered with Gold Coast Health Plan to implement a new pilot program to fund a health case manager — who speaks Mixtec and Spanish — to help Medi-Cal families navigate the healthcare system, make appointments and get transportation and translation services. Since August 2017, the new health case manager has helped 251 patients in 86 families, Gonzalez said.

The problems between Medi-Cal patients and their physicians are also structural, advocates said, and require structural changes.

For Williams, the stigma also has to do with the low reimbursement rate physicians are paid for serving Medi-Cal patients and the lack of financial incentives for serving this population.

“Some practitioners said there’s the constant back-of-the-mind feeling that they’re not going to be paid on time, so if they accept Medi-Cal patients, they’re subsidizing their service, because they could go to private insurance and get paid quickly,” he said.

“We have to figure out how to incentivize care for African-Americans, Latinos and low-income Californians in general, because the system does not offer incentives to provide for the least of these,” Williams said. “It’s developed to provide efficiencies.”

Cava of the Department of Health Care Services, meanwhile, said that the department “performs a medical audit annually, which includes a full review of the health plan grievance and appeal system/process, and contacts health plans on a quarterly basis if they are deemed to have a high grievance and appeal submission rate.” Prior to collecting specific data on Medi-Cal patients’ experiences with providers, these grievances were lumped together under “quality of care” complaints.

For Dr. Muhammad, improving Medi-Cal patient experience starts with clinics. She has seen — and worked in — clinics with run-down furniture, extension cords hanging from the ceiling, unfriendly staff and even dead roaches on the floor. This, she said, only reinforces the perception that Medi-Cal customers are treated differently.

Instead, she said, there should be greater oversight for the federally qualified health centers that primarily serve Medi-Cal patients, ensuring that facilities are clean, aesthetically pleasing and offer a range of programs to promote community wellness.

“We need to go around and say, ‘If you get federal money to provide services to these patients, it has to be put back into the clinic and not just into the pocket of the CEO and the board of directors; it has to be invested back into the community,” she said.

“That would be a big step in making people feel that we’re here to serve you.”

SOURCE: Story By Caitlin Yoshiko Kandil | California Health Report

(2) comments

NJL

I absolutely disagree with this. We are a Speciality practice in Orange County and treat all of our patients with dignity and professionalism. We find that the Cal Optima/MediCal patients are some of the most demanding, rude and inpatient patients we have. So many have come to our front desk to sign in and refused to fill out our paperwork or give us their insurance cards. They use foul language towards our staff and other patients. They are so uncooperative, especially when making appointments. For the non-english speaking patients we remind them of the interpreter services they can utilize and they refuse demanding we complete their paperwork and translate. I understand there may be a stigma relating to MediCal recipients but MAYBE just MAYBE there is a reason??? JUST ONCE I would love to read an article about, as I call it, The Other Side of Healthcare, about how patients act in the healthcare setting. Start a survey, I am sure you will be very surprised.

healthcare

I strongly disagree with this article about Medi-Cal/Cal-Optima recipients feeling stigmatized, discriminated by healthcare providers. I am an office manager working in the Southern California healthcare since 1991 until now. I am currently an office manager for a specialist for 19 years. As all of doctors know, they are constantly under the scrutiny of medical boards for their medical delivery to their patients. Therefore, they provide their utmost medical knowledge, professionalism and
understanding to the patients otherwise, they will get sue or their board will be suspended. Most of the doctors will not recognize which patients are PPO, HMO, Medicare, or Medi-Cal/Cal-Optima to discriminated the patients. As for the medical staffs attitudes and discriminate against Medi-Cal/Optima patients, these views need to be clearly clarify with extensive research to support this article. As for myself being a covering front desk staff and visited other medical offices for the past 19 years, I can tell you this: Medi-Cal/Cal-Optima patients are very rude, demanding and verbally abusive with threatening remarks toward the front desk staffs and doctors. On average, our specialty office received 100 calls a day. Most of the calls are from Medi-Cal/Cal-Optima patients wanting to be seen urgently and same day appointment without willing wait any where1--2 hours or less. We recommended them to go to ER because they declined knowing that the waiting time in ER is about 4-5 hours. They demanded their authorizations for office procedures, tests, surgeries to be urgent and ASAP. If we don't comply to their demands, they verbally threaten and abusive toward the front desks staffs, the managers, the doctors. They called up their IPAs, their health plans and file official grievances toward the staffs and the doctors. They yelped and online evaluated the office with 1 star attaching falsifying details. They article stated that nearly 7000 Medi-Cal/Cal-Optima patients filed the grievances because they don't work, they don't pay for their medical expenses compares to HMOs and PPOs and Medicare patients. Has any body doing research on those populations? I can go into extensive details about the bad treatments front desk staffs received from Medi-Cal/Cal-Optima patients through out my 19 years experience as well as stories from other offices. But I do know one thing, that none of the doctors, the California's Department of Healthcare Services, the IPAs, the health plans, etc. is that the medical staffs work 8 hours a day, 40+ hours a week and then pay 20% of their pay check to our states and federals so that the our government in turns give free medical care to Medi-Cal/Cal-Optima patients who are in turned abusive/threatening to those who have given free medical services in the first place. Recently a Medi-Cal/Cal-Optima patient told me "McDonald pays $10/hr with the expectation that the food services staffs have to serve customers with a smile no matter what. I totally agree with her because customers have to pay cash/money to get the good and the services. Whereas, the Medi-cal/Ca-Optima recipients or patients do not pay a single dime to the staffs or to the government but expecting urgent medical services with demanding abusing threatening attitudes. I sincerely request you all to give yourself 1 week to work at a front desk, back office, referral coordinators, schedulers and to know what is like before you can published a
well documented article about "Medi-Cal Patients Report Feeling Stigmatized, Discriminated Against by Healthcare Providers". It is the other way around.

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