The reality of a high Medicaid population:

In my practice, and I believe in many other practices in the area, 90 percent of the clientele is Medicaid. Therefore, in order to generate the income of a normal patient load elsewhere, we have to see double. In other words I have to see 60 patients to make the income of 30 patients.

Doctors outside of the border area who do their homework already know this. Two years ago I tried to recruit a physician to help me. I sent out 600 notes, and spoke with about 30 who replied.

Many of them asked if my patient population was high in Medicaid, and I answered yes. They said they weren’Â’t interested. Some of them also stated that they heard that Medicaid was going to cut further on payments and what it will allow to be billed during an office visit. And they were right.

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  • Anonymous

    Also depending upon the area of the country that you are in, Medicare does not pay much better than Medicaid. For a surgeon, Medicare payments do not make up for the added complexity of the procedures and perioperative care in elderly, frail patients, i.e. 70 y/o patient requiring a hip replacement or thoractomy.

  • ismd

    In New Jersey, many Medicare patients have Medicaid as their secondary. The state no longer has Medicaid pay the 20% of what Medicare allows, and the patient isn’t responsible. Not only are many docs in the state no longer taking Medicaid, they’re not accepting Medicare patients with Medicaid as secondary insurance.

  • Anonymous

    That is even assuming that you actually get paid at all by your local Medicaid carrier. In many states, Medicaid is farmed out to bottom-feeder managed care insurance companies that have lower schedules and worse payment records than the Medicaid agencies themselves.

    And don’t forget the difficulty in servicing the Medicaid patient population. Surveying my own practice, thankfully now changed in both location and patient mix, 40% of the patient appointments given to Medicaid beneficiaries were no-shows, and nothing short of dismissal could cure that problem. Patients were chronically late but thought nothing of demanding someone else’s appointment time when they bothered to show, which was stressful on staff and physicians. Accounting for no-shows and downcoding and non-payment, one cash-paying patient–and my fees weren’t all that high to begin with–was worth ten medicaid appointments. Is it any surprise so many doctors refuse to deal with Medicaid at all? It is abuse, plain and simple, and at a net loss to the practice, no less.

  • John J. Coupal

    Not only do we have illegal immigrants draining our medical, education, and law enforcement budgets, but we have SICK illegal immigrants and those who decide to have their baby north of the border.

    That’s about to end.

  • Anonymous

    Oh come not don’t you guys know medicare pay’s “handsomely”. After all CJD said so and since he knows more about the subject than we do…he MUST be right.

  • Anonymous

    “Not only do we have illegal immigrants draining our medical, education, and law enforcement budgets, but we have SICK illegal immigrants and those who decide to have their baby north of the border.”

    Shut the F up! Who made you emperor of America? Bet you wouldn’t want to trade places with one of those poor illegals. Anyway, aren’t we all illegals since we stole this country from the Indians anyway?

  • Anonymous

    The last poster is at a loss for clear ideas so he resorts to baser words to express primitive instincs.

    I’m also certain that no one would want to trade places with those poor illegals; that’s why we want to prevent the first half of such a trade from occuring by preventing their arrival.

    As far as the indigenous population in North America prior to the european migration, yes, the land was stolen, the peoples killed and the women raped. And then 20 or so generations later my ‘people’ migrated to this continent.

    But then the natives here when the europeans arived were not the same natives as originally colonized this continent. So their claim is weakend. The original claim must go to the first primal ooze that bubbled up from a hot spring combining the DNA building blocks of A, T, G, and C.

  • Anonymous

    “The original claim must go to the first primal ooze that bubbled up from a hot spring combining the DNA building blocks of A, T, G, and C.”
    Not so. The latest scientific finding is that all human DNA can be traced back to Africa and that the first human migration to North America was from Asia to Siberia to Alaska to the West Coast.
    Now if you believe in Intelligent Design, then Adam and Eve were created in the Garden of Eden in Nebraska.

  • Anonymous

    I work for a large ER physician partnership. If you add the self pay population plus the medicaid population at a particular ER site it will determine the viability of the contract. If that number equals or exceeds 50% (lethal dose LD50)then you will not be able to make a living delivering emergency and life saving healthcare.

  • Anonymous

    Anon 935,
    And I’m sure that’s when your group asks for subsidy from the hospital, because there won’t be a group that will want to cover that ER without a guaranteed pay.

  • Anonymous

    “After all CJD said so and since he knows more about the subject than we do…he MUST be right.”

    When you can’t prove someone wrong, make up what they said and then prove it wrong!

  • Anonymous

    10:27

    The hospital may provide a subsidy or we may walk from the contract. The hospital may choose to close the ER or trauma progam or go bankrupt in its enirety. It happens again and again and healthcare becomes more and more precarious for even the most wealthy or well insured because the ER/hospital beds are less accessible

  • Anonymous

    Anon 6:59 makes a great point. Accepting a high proportion of Medicaid patients is detrimental beyond just the low reimbursement schedule. The population that comes with it is far more challenging to treat. I’ll probably get slammed for making these generalizations, but any real doctor knows they’re true: they are more likely to no-show, more likely to drug-seek, more likely to lead unhealthy lifestyles (and thus have multiple risk factors and diseases), more likely to be non-compliant, etc. The no-shows cost you financially, and the rest makes treating them far more of a hassle than seeing other types of patients. (My disclaimer: yes, I know not ALL of them are like this.)

    Some docs continue to take it because it never really occurs to them not to, some feel more of a moral duty to accept them (or are looked at as snobs if they don’t), and some economically can’t afford not to take it because they work in lower-income areas.

  • Anonymous

    “When you can’t prove someone wrong, make up what they said and then prove it wrong”

    Doh…you were the one saying we are payed “handsomely” “outside the market”. Don’t remember what you were typing dude.

  • John J. Coupal

    It would be scary if all the Anonymous” posts above are by the same person!

  • Anonymous

    “Anyway, aren’t we all illegals since we stole this country from the Indians anyway?”

    NO!, WE ARE NOT ALL ILLEGALS!

    I think you need to do your own research regarding the Kennewick man discovery in Oregon. I believe that the Kennewick man find indicates that the first people to inhabit North America were caucasian Europeans. These caucasians were apparently then exterminated by Asian peoples who crossed the Bering Strait and came into North America. These Asians then became what people today call the “Native Americans”. Many years later these “Native Americans” were decimated by migrating caucasian European settlers. It is interesting to see reports of how current “Native Americans” pressured the US government and the Army Corps of Engineers to bury the Kennewick man site under tons of rock so that no further archaelogic investigation could be done at the site. These American Indians do not like the idea that the true original Native Americans were caucasians.

  • Anonymous

    “Doh…you were the one saying we are payed “handsomely” “outside the market”. Don’t remember what you were typing dude.”

    Your memory is failing you.

    You’re paid well period, by all objective measures.

  • Anonymous

    That’s why fewer docs are taking medicare and in some states there are area’s it’s almost impossible to find medicaid providers taking patient’s. So much for “handsome” reimbursement.

  • Anonymous

    Apologize .Confess “You’re paid well period, by all objective measures” Confess or I,m ready with my ***k . Oops I’m not finding it!