By PL Jeter
Making sure Medicaid patients have access to medical care, bringing Medicaid reimbursement in alignment with Medicare reimbursement, and making sure reimbursement rates follow cost-of-living increases are the top advocacy priorities for Harinath Sheela, MD, a partner in Orlando's Digestive and Liver Center of Florida since 2005, medical director of the Endo-Surgical Center of Florida, and a passionate leader of the Orange County Medical Society Political Action Committee (OCMS-PAC).
"It can be very difficult for Medicaid patients to get care when they need it, due to reimbursement issues; many local physicians do not take Medicaid," explained Sheela. "This often results in those patients resorting to the hospital emergency room for care often, which is difficult for patients and costly for the system. There is no continuity and they often end up in the emergency room again seeking care or relief for their symptoms."
Sheela's advocacy work extends beyond Central Florida, as the OCMS-PAC seeks significant positive change at the federal and state levels. "To help Medicaid patients have access to care, we need to change the reimbursement," he emphasized. "Medicaid reimbursement needs to be on par with Medicare so that it is accepted by most physicians and medical facilities with improved access and avoid unnecessary emergency room visits."
Sheela is also lobbying for decreased administrative burden between physicians' practices, outpatient surgery centers, clinics, hospitals and insurance companies. "It takes a lot of staff to be able to get reimbursed by insurance companies," he pointed out. "There are pre-authorizations required in many cases and multiple phone calls, letters and documentation to get a visit or procedure approved. The rules are getting more and more complex for physicians to get reimbursed for services and it should not be this way."
Making sure reimbursement rates follow cost-of-living increases would help ease the financial burden of physician practices. "Most physician practices pay higher costs every year for medical supplies, phone services, employee salaries, et cetera," he said. "The list goes on and on and many services' costs increase at least to accommodate the cost of living."
Sheela's goals for the OCMS-PAC through 2018 are to continue to strive to increase access to care to as many residents as possible in Central Florida. "The system needs to be more efficient and allow physicians to focus more on medical care and less on administrative work to get reimbursed for services provided," he said. "This is an ongoing work and we believe that by organizing ourselves and creating awareness of the issues we all face daily, we can make a difference and increase the quality of life."
A native of Hyderabad, India, Sheela completed medical school at Spartan Health Sciences University in St. Lucia, followed by an internal medicine and gastroenterology residency at the University of Connecticut. He completed a three-year fellowship followed at Yale University School of Medicine before he relocated to Orlando to join the five-physician practice, Digestive and Liver Center of Florida.
At the Digestive and Liver Center, Sheela treats internal conditions including inflammatory bowel diseases, irritable bowel syndrome, hepatitis B and C, metabolic and other liver disorders. As chairman of Florida Hospital's Department of Gastroenterology through 2016, an assistant professor at the University of Central Florida School of Medicine, and a teaching assistant professor for Florida Hospital's internal medicine and family practice residency programs, he's typically the go-to guy for unexplained abdominal pain, the most common reason for hospitalization behind chest pain.
Sheela and his brothers, also physicians in the practice, rotate travels to their homeland to work with state and local governments to provide access to healthcare in rural villages. They helped build a 30,000-square-foot healthcare center with a walk-in clinic and an emergency room for acute care. Fellows and medical students staff the center around the clock, but its remote location 100 miles from a commercial hub has its drawbacks. "No one wants to live there; they go for three-month rotations," explained Sheela, whose family raises money and connects medical students with teaching hospitals. "We created that model with the professors. Our goal is to be self-sustaining."
Regardless of whether at home or in his homeland, Sheela said the best ROI of his medical career is seeing the relief on the faces of patients and their families after he determines a liver-related problem and implements a solution. "It's immediate gratification," he said, to find the problem, treat it and ease or eliminate the pain.