Medicaid enrollees to sign a "personal resonsibility contract"

Great idea, but there’s no way to enforce this:

West Virginia families served by Medicaid could face a reduction in benefits if they refuse to sign contracts promising to show up for doctors’ appointments and to use the emergency room only for emergencies.

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  • Anonymous

    This just in: members of Congress to sign a “personal responsibility contract.”

  • Anonymous

    Why single out the Medicaid population? Why not have contracts for everyone?

  • Anonymous

    Many practices have standing policies that attach charges to patient accounts for missed and uncancelled appointments, or cancellations within a set period before a scheduled appointment (usually one day or less). Those policies apply regardless of how the patient covers their bill.

    Medicaid will not pay providers for any services not rendered. Penalty charges are considered to be charges for which no services were rendered (true, the patient wasted the appointment), and most Medicaid patients don’t have funds to pay their penalties themselves. So the practice loses appointment time for which it receives nothing. And it isn’t a trivial loss when it comes to Medicaid patients. In my own practice–fortunately changed for the better–Medicaid patients were no-shows for forty percent of their scheduled appointments. When you figure that the reimbursement schedules in many cases don’t cover the costs of service, then you subtract the 40% discount for wasted visits, and to that subtract the costs of the burdensome paperwork, money costs of delay to payment and outright denials that come with those programs (many Medicaid agencies subcontract to private deep-discount managed-care plans); you can see Medicaid is seen as a loser. Many doctors won’t take that and want nothing to do with those patients. Who can blame them? In many areas, Medicaid patients have a hard time finding willing doctors.

    Unfortunately too many Medicaid enrollees do not have habits of good planning or respect for value of professional time, and hence see no value to missed appointments. Since they pay nothing for services, they have little appreciation for the cost of those services, whether used or wasted.

    Why single out the Medicaid population? I don’t. But the federal and state governments are picking up the full tab for their care, and where the behavior of recipients is undermining the effectiveness of the program as a whole, and alienating participating doctors which the program requires to work, the government feels it has a right to say to those patients that something is expected of them. I can’t argue with that.

  • Anonymous

    Many practices have standing policies that attach charges to patient accounts for missed and uncancelled appointments, or cancellations within a set period before a scheduled appointment (usually one day or less). Those policies apply regardless of how the patient covers their bill.

    Medicaid will not pay providers for any services not rendered. Penalty charges are considered to be charges for which no services were rendered (true, the patient wasted the appointment), and most Medicaid patients don’t have funds to pay their penalties themselves. So the practice loses appointment time for which it receives nothing. And it isn’t a trivial loss when it comes to Medicaid patients. In my own practice–fortunately changed for the better–Medicaid patients were no-shows for forty percent of their scheduled appointments. When you figure that the reimbursement schedules in many cases don’t cover the costs of service, then you subtract the 40% discount for wasted visits, and to that subtract the costs of the burdensome paperwork, money costs of delay to payment and outright denials that come with those programs (many Medicaid agencies subcontract to private deep-discount managed-care plans); you can see Medicaid is seen as a loser. Many doctors won’t take that and want nothing to do with those patients. Who can blame them? In many areas, Medicaid patients have a hard time finding willing doctors.

    Unfortunately too many Medicaid enrollees do not have habits of good planning or respect for value of professional time, and hence see no value to missed appointments. Since they pay nothing for services, they have little appreciation for the cost of those services, whether used or wasted.

    Why single out the Medicaid population? I don’t. But the federal and state governments are picking up the full tab for their care, and where the behavior of recipients is undermining the effectiveness of the program as a whole, and alienating participating doctors which the program requires to work, the government feels it has a right to say to those patients that something is expected of them. I can’t argue with that.

  • Katie

    The no-shows problem definitely sounds like a waste of resources and should be punished, but I’m not so sure about the part about only using the emergency room for emergencies. How, and by whom, is emergency defined? I don’t think if a person has chest pain, they should be expected to have the medical knowledge to distinguish between a gas pain or indigestion and a heart attack. I agree that they shouldn’t walk into the ER with minor scrapes. So I would just hope that the definitions are really, really clear, and don’t require a regular person to have expert knowledge to know the difference.

  • Anonymous

    This sounds exactly like another way to adding more numbers to the people in this country not receiving medical care.

    Lets get something straight here. most PCPs, GPs, family doc’s do not take medicaid patients. Alot of the ones that do have stopped doing so or atleast have stopped taking on any new ones. Why is that? It’s because medicaid has again lowered it’s reimbursements to drs.

    So, now there is this entire group of people who have no family doc’s or will soon be losing their family docs, and their being told they can’t go to the ER for non-emergent issues.

    What is really scary is this is being ordered by our Govt. Is this genocide?

    Is this not a fancy way of killing off the poor people in this country?

    Specialists arent going to do these people any good. Try going to one without a PCP referral.

    Where and how are these people supposed to get refills on their meds.?

    Something better start getting done about the fiasco that is our health care before we become the “spawn of hell” that we are accused of being.

  • Anonymous

    “Is this not a fancy way of killing off the poor people in this country?”

    No chance of that ever happenning. The medicaid population breeds and reproduces like bunnie rabbits.

  • Anonymous

    Yes, a percentage of that population breeds like rabbits, and a percentage of middle class and even upper class breeds the same way. This article isn’t discussing the breeding habits of the American people, it is discussing medical care coverage for a large group of people.

    Many, many of the elderly have medicaid in addition to medicare. Medicare is their primary and medicaid is the secondary, but, medicaid has bought them in, to their medicare part B and prescription coverage and pays their premium so they control those people. None of those people are breeding like rabbits!

    How many elderly people come to the ER because of a symptom that has scared them? How do they know if at 70 years old when they have chest pains that its not a heart attack?

    The quicker we get Bush out of that office (damn them democrats for running an ass like John Kerry), the better off everyone will be.

    If you agree that it’s ok for all these people to not receive medical care then you better start evaluating your morals.

  • Anonymous

    “Medicare is their primary and Medicaid is the secondary”‘

    Reality: nothing is their secondary. In my state, the Medicaid schedule is at the Medicare 80% level, so the Medicaid contribution is zero. Hey, but they have coverage. So many doctors refuse Medicaid as a secondary since it covers nothing.

    “If you agree that it’s ok for all these people to not receive medical care then you better start evaluating your morals.”

    Put your money where your mouth is. I don’t have to agree to work for nothing, or for so little that out of the reimbursement, after the expenses are paid, that I get nothing. I just love it when liberals take the supposed ‘high” road on medical access, playing the moralistic scolds about how poor people should just have access (and it’s just going to have to be the doctors’ problem to help them out.) Funny thing, I don’t ever get any volunteers coming to me to say they’d like to buy my office some supplies, or do some volunteer work so that resources could be available to see folks for the kind of money Medicaid pays. When I see that kind of interest, or when those same preachy taxpayers cough up the kind of reimbursement that fairly pays for the services they think Medicaid ought to be buying, then I will be interested. Until then, I am just as happy to tell the moralist hypocrites to just shut up and not to expect more than what they are paying for, which, with Medicaid, isn’t much.

    And as for expecting single-payer to save you, that is just laughable. It is failing everywhere else it is being practiced. Medical care requires work, and work has to be paid for. Stick with the older fairy tales, like Rumpelstiltskin. There at least is the entertaining hope you will spin straw into gold.

  • Anonymous

    “Medicare is their primary and medicaid is the secondary”‘

    Reality: nothing is their secondary. In my state, the Medicaid schedule is at the Medicare 80% level, so the Medicaid contribution is zero. Hey, but they have coverage. So many doctors refuse Medicaid as a secondary since it covers nothing.

    “If you agree that it’s ok for all these people to not receive medical care then you better start evaluating your morals.”

    Put your money where your mouth is. I don’t have to agree to work for nothing, or for so little that out of the reimbursement, after the expenses are paid, that I get nothing. I just love it when liberals take the supposed ‘high” road on medical access, playing the moralistic scolds about how poor people should just have access (and it’s just going to have to be the doctors’ problem to help them out.) Funny thing, I don’t ever get any volunteers coming to me to say they’d like to buy my office some supplies, or do some volunteer work so that resources could be available to see folks for the kind of money Medicaid pays. When I see that kind of interest, or when the preachy taxpayers cough up the kind of reimbursement that fairly pays for the services they think Medicaid ought to be buying, then I will be interested. Until then, I am just as happy to tell the moralist hypocrites to just shut up and not to expect more than what they are paying for, which, with Medicaid, isn’t much.

    And as for expecting single-payer to save you, that is just laughable. It is failing everywhere else it is being practiced. Medical care requires work, and work has to be paid for. Stick with the older fairy tales, like Rumpelstiltskin. There at least is the entertaining hope you will spin straw into gold.

  • Anonymous

    You have totally and completely missed the point. Where did I say this was the Doctors fault? Where did I say the doc’s should just do things for free?

    What I said is that there is a large group of people in this country who has no way to obtain medical coverage. If thats fine with you then so be it. But, don’t take your attitude with me telling me that I’m wrong for caring about the medical care,or lack of, for many people in this country.

    If you had become a Dr. because you “really” wanted to help and care for ill people, this issue would mean something to you. Instead, you use it as a way of asking for volunteers to help you make more money. Talk about spinning straw into gold!

    As for a hypocrite, I didn’t become a dr. and swear to help ill people, you did. Obvioulsy that is not your intent, making money is what you became a doctor for. Dont preach to me about how good you think you are or how bad I must be…

    Speaking of volunteering, do you do any of it? Or is that below you?

    Poor people and medical care is a problem in this country. Anyone who thinks otherwise is like an ostrich with their head in the sand. Killing these people off does not sound like a good option to me. I’m sorry it seems to be appropriate for you.

  • Anonymous

    We have a national health care system. It is called “go to the ER” Federal law says you have to be treated. Of course it is an unfunded mandate.

    Many uninsured could buy health insurance. They just gamble and don’t. Many medicaid patient’s probably could too if they emptied their purse of cigarettes, cell phones, and keys to the new lease on the Ford explorer

  • Anonymous

    anon 2:43
    Your just talking off the top of your head without using any common sense or facts whatsoever.

    Approx. 20% of taxes fund medicaid? We should be talking about the other 80% and where that goes.

    In 1985 only 8% of taxes went for funding of medicaid. Enrollment in medicaid jumped by one-third during the years of 2000-0004. Why?

    It’s because the economy took such a nosedive as businesses closed and more people lost their jobs and
    income. Did you get that? It grew by one-third in 4 years and another 5% in 2005. Your profiling of medicaid recepients being generational and living their entire life that way isn’t it at all. Many of the people now on medicaid have previously had their own ins. But this economy thing forced them to get new lower paying jobs. Its hard to keep going to work at your same job everyday when your boss has locked up and moved to another country.

    Another thing is that many employers who previously offered ins. to their employees are no longer doing so.

    So yes, medicaid has grwon from 8% of our taxes to fund in 1985 to about 20%…21 years later. How does that compare with how everything else has increased in over 2 decades? I still want to know about that other 80% of taxes. don’t you?

    In april President Bush wanted to cut 40 billion dollars (thats billion with a “B”) over a 10 year period from the medicaid program. Congress agreed to cut 10 billion over 5 years. OK, fine, so where is his plan for all these people that he wants to cut off these roles? He doesn’t have a plan because Bush couldn’t care less about the American people. Just cut 40 billion dollars and to hell with those people. But, thats alot of people he’s telling to go to hell.

    There are more than 53 million people in America on medicaid. It is the largest single healthcare plan that there is. One-third of them have had to seek medicaid since Bush took office in 2000.

    You tell me where the root of this problem lays?

  • Anonymous

    “If you had become a Dr. because you “really” wanted to help and care for ill people, this issue would mean something to you. Instead, you use it as a way of asking for volunteers to help you make more money. Talk about spinning straw into gold! “

    I became a doctor because I liked medicine and wanted to do that kind of work. I happen to make my living at it, which is my circumstance and that of most doctors. I haven’t got a government grant or a big trust fund or a large institutional employer who provides me salary, pension and benefits. Everything has to come from my practice. I do not believe I have any sort of monopoly on the ability to help people, and “helping” people is something that anyone who provides any kind of economically productive work can be said to do. It is a good thing that what I do is beneficial, but that for me is not enough. It also has to provide me a satisfactory living and as much as I can help, a satisfactory economic return on what I have invested, which is a lot.

    So when folks come along and want my work but can’t or won’t pay me for it, that matters to me. So what if they “need” what I do? People who have low incomes but “need” food are given food stamps if eligible. They use those like money, and pay grocers the fair price for their goods, at least for those things they are permitted to buy. They don’t get to buy those goods at the grocer’s cost, or below the grocer’s cost. So why then should the same government get to buy my services at my cost, or even below that? And why is the moral onus to accept those terms greater for me than for any other provider of necessary goods and services?

    I do not have a moral obligation to satisfy your sense of outrage at the inequities of access to medical care simply because I have the ability to provide those services.

    Your reply misses the point. Taking Medicaid is a kind of volunteering, it is working for nothing in many cases. For someone with a business to support and the need to make a personal living, there is only so much of that a practitioner can do. Do I “volunteer”? When I see Medicaid patients who don’t pay me for my labor, would that meet your definition of “volunteering?” Perhaps when I come into the ER in the middle of the night to consult and see someone who has no money and no insurance and from whom I will never see any compensation, would that meet your definition of “volunteering?
    I think of it as taking, since most of the time I am not given a choice whether to see the patient or not, so the appropriation of my labor is not entirely my choice; sort of like letting folks break into the store to get the stuff they “need”.

  • Anonymous

    bush hater 449,

    The unemployment rate is low, the economy is in great shape. Who decided that medical care at any cost is a “right” and that an employer is obligated to give it. Who will pull the cart when everyone wants to ride?

  • Anonymous

    We aren’t talking about unemployment rates. We’re talking about a large percentage of people who are on medicaid and Drs. who don’t accept it.

    That seems like a strange comment I admit, but medicaid has nothing to do with unemployment anymore. Well it does but the majority of people receiving medicaid are not welfare receipents. That use to be the case but the majority now is the working poor, disabled and the elderly.

    You aren’t getting it at all! Do you have any idea how many businesses have closed forcing people to move from 20-30 dollar an hour jobs to 8-10 dollars an hour? But, hey what difference does it make how much money they make, as long as unemployment rates aren’t effected?

    You are one of the ostriches living with your head in the sand. I guess that makes your life a bit easier to handle that way. THE WORLD IS WONDERFUL!

    As for Bush,your one of the 30 something percent who thinks he is doing a good job. Spend some time thinking about that. I didn’t start out not liking Bush. I voted for him in 2004. I would do so again if the only other choice was John Kerry and John Edwards. But, face facts here and don’t come at us with just a statement that says “unemployment is down, the economy is fine”. The economy is NOT fine and unless your somewhat off then you know it as well as I do.

  • Anonymous

    “who decided it was a right?”

    I guess the govt. did when it approved those people who receive medicaid. They evaluated them and found that they met all qualifications and said “we are going to give you health coverage through medicaid” Lucky them huh! That means they had to lose their homes, bank accounts, cars and anything else of any value whatsoever to be eligible for medicaid. It is not a situation where people go and apply and they say, “Oh well yes, lets give you health coverage today.” It only happens when people are at the lowest point in their lives.

    By refusing to accept what they are entitled to you only make it worse.

    Your the one who has taken their right to receive medical care away.

  • Anonymous

    According to this report:

    http://www.hschange.com/CONTENT/505/#tr2
    Tracking Report No. 6

    Granted it is a few years old but I couldn’t find a more updated one. It states that more than 70% of physicians spend less than 5% of their practice time on charity cases.

    You always talk about how much time you give away and how you work for free. Where are the facts to support it? I think it sounds like a good thing for you to say but most likely not true. Also that report doesn’t say that those 70% of physicians spend 5% of their time on charity cases, it states they spend “less” than 5% of their time on charity cases.

    As for medicaid, again you want everyone to believe that it is charity and that you really get no reimbursments for those patients. In this same report it tells us that physicians in Ohio were reimbursed 34.00 for each office visit by each medicaid pat. and that ARK. physicians were reimbursed 66.00. Then it talks about NY with a reimbursement rate at 11.00 per patient, but the average was the 34.00.
    That is for one pt. during one visit at apprx a 6 minute time frame with the doctor. That is not providing charity. Most people can’t even imagine making 34.00 for 6 minutes of time.

    Physicians (some, certainly not all)are so out of touch with reality that it would be funny if it wern’t for people dying.

  • Anonymous

    Anon. 7:55 wrote:

    “By refusing to accept what they are entitled to you only make it worse.

    Your the one who has taken their right to receive medical care away.”

    What a perfect example of lazy, self-righteous liberal deflection. Medicaid may be the entitlement of the people you speak of, but having someone work for that kind of payment, when it doesn’t represent fair or reasonable compensation, is not.

    Average of $34 per visit at 6 minutes per visit, you say? Maybe your doctor’s practice, but not mine. Even if it were true, that is not an especially high figure for gross collections. That’s right, gross collections (you seem to be clueless that we’re talking about receipts for a whole business, not just a doctor’s pay). Now deduct 80% for practice overhead–a higher percentage than average since while Medicaid schedules are discounted, practice costs are not– then you are looking at a more realistic estimate of the doctor’s share. And remember, that is for seeing ten patients an hour, a practice sweatshop. The doctor only gets paid after the eighth patient is discharged.

    Your figures are as fake as your argument and your ridiculous effort to place the blame for lack of access on those who refuse is to be sweatshopped by the government. You write as if you hate and resent doctors. You obviously resent the fact that they earn good incomes (and you completely fail to appreciate the time and cost that qualifying to practice as a physician requires). Yours is the ethic of the mooch, the taker who wants the fruits of the labor but not the labor. Tell me, would you be as indignant if I were a nurse, or a factory worker being underpaid by the government? I doubt it.

  • Anonymous

    Well, I’m no mooch..I’ve worked for over 35 years and have paid my way. that doesn’t mean I’m blind to what goes on around me.

    I don’t hate Drs. at all. But, when you say that taking care of medicaid pts. is all without pay, that isn’t the truth. It may not be the pay you want or what you get from other forms of ins. but it is not without pay.

    I quoted figures exactly as they were written in the report that I gave you the address for. If that report is wrong then lead me to a better one that is more updated.

    As for the 6 minute office visit, I got it right here on this BLOG. Not long ago Kevin had posted something where some of the Drs. were talking about their visit times with patients being reduced from 15 minutes to 6-8 minute visits.

    But, ironically, I think Drs. are about the best profession there is. We “need” Drs..BTW…I have good ins..But, I know people who struggle everyday because they can’t get dr. appts. or because they can’t buy their medications. I’am not of the attitude to think “well sorry about you, but as for me, I have really good ins.” I’am not that uncaring about other people.

    When someone says “I worked really hard all day and made nothing doing it” most of us assume you mean that literally. We don’t understand that what you meant is “I didn’t get paid what I would have liked to get paid.” We can relate to that. We live that everyday.

    Maybe you’re just trying to live a lifestyle that is beyond your means?
    Like all those people who use to have really good jobs, and then they didn’t. They had to make adjustments in the lifestyle they live.

  • Anonymous

    It is not a matter of getting paid “less than we want to”. It is usually a case of NEGETIVE numbers in many situations. If medicaid pays 30$ for an office visit and it costs 10$ per patient for malpractice, 5$ cost to submit the bill, and 25$ per patient for staff/office overhead cost then I lost 10$ to see that patient. This is not a case of “living beyond my means”. A neurosurgeon friend of mine tells me about a case where he put in a 300$ shunt during 2 hour surgery and saw the child in the office for follow up appointments and got a payment of 50$ from the medicaid HMO for the entire length of care.

  • Anonymous

    bush hater,

    You are the ostrich. It is a global economy. You are in competition with 6 billion on the globe so sorting widgets won’t pay 30$/hr anymore. Learn some new skills, get a degree, adapt. Even with all his flaws, Bush has nothing to do with it. I am adapting by not taking medicaid enrollees anymore. I will still so charity work which I enjoy but I won’t play the joke of a medicaid game.

  • Anonymous

    Anon 10:40, your major error is in assuming that $34.00 per visit represents the doctor’s net income, not a payment to the practice. As has already been explained, a majority of the income for the whole practice goes to overhead (lease for the office space, salaries for office staff, liability insurance, utilities, the cost of claim submission, etc)with whatever is left over going to the doctor as “profit”. These costs are pretty much fixed regardless of how much the doctor brings in through billing. So assuming that per patient the office needs $40.00 to cover daily overhead, and with the average private insurance/cash paying patient yielding more like $60.00- $100.00 per visit, the physician has a handsome amount left over from which to garner income. When Medicaid pays $34.00 per visit, yes, the office loses money on that patient.

  • Anonymous

    Anon. 8:05:

    Did you get the posting time wrong or did you just not read my post? I believe I explained exactly what you have said. Believe me, I understand the issues relevant to accepting Medicaid in a private practice as well as anyone who does that can. I also know that accepting any more than a small minority of a practice census from Medicaid can wreak havoc with a practice’s finances and put that practice financially under water. Read my post again.

  • Anonymous

    I think he just got the anon’s mixed up. I was typing as the other anon and I’m sure his commment was for me.

  • Anonymous

    Sorry, wrong time. That was directed to the post before you, 9:41.