The doctor who wants to serve that population needs either an alternative funding source or subsidy of some sort, or need to limit the numbers of those patients so he can support his medicaid/medicare mission with some paying patients.

The powers that be just look to see if there are any providers without regard to quality of service. If there are, even if they are sham mill operations, they deem the payment rates to be adequate.

In the end, providers who struggle to make inadequate payment work do a wonderful work for their particular patients, but help feed a system that is immoral in that it steadily chases out good care with bad.

As usual, I depends.

I suppose you could do with one or even none, if you didn’t mind answering phones between patients. If you file claims in-house, you need staff. If you are generating a load of five hundred visits a month, you would be wise to bring filing in-house unless your labor costs are prohibitive. Outservice billers are generally not as thorough and definitely do not like to spend time chasing denied claims. They see more money from time spent on fresh claims. If you are booking twenty patients a day or more, you need a receptionist who can schedule. Any more than that, you will likely need a second person who can do checkout and generate receipts. If you are seeing twenty patients a day, you will probably want a nurse or medical technician to improve your patient flow.
So the staffing adds up. One doctor with seven FTEs is a bad ratio, unless you are doing extra services in-office like imaging or laboratory or EKGs.

The problem with the office in the post was the excessively large census of Medicaid patients.
The problem is only made worse by the high staffing costs.

My experience with an urban Medicaid population was that ten scheduled appointments with Medicaid-”paying” patients had the same contribution to practice revenues as a single discounted cash-paying patient.

The only thing I can say about this is, I don’t know if those seven people were full-time or part-time. But yes, seven full-time staff is way too much.

Maybe some of that staff was nurse-practitioners or PA’s, which could skew the ratio. But I don’t know.

Just becaase a group of 3 docs can get by this 13.5 FTE does not mean a solo practice can do with 4,5

Please.

I was talking with a Canadian colleague of mine last week and telling him of our Medicaid/care woes and he told me that in B.C. the GP’s were now being paid 25% MORE for an average office visit for those over 65 and as well there were bonuses paid to physicians on certain ICD codes for chronic diseases such as diabetes, CHF, and the like. This would apply to a large portion of my Medicaid patients too.

Interesting that a single payer system should do that. It took a lot of lobbying by the CMA. Considering that Medicaid and Medicare have a single payor system too maybe the AMA isn’t putting up a very good fight fo us.

We all do one another a disservice by seeing how much we can absorb before drawing a line in the sand. Medicaid is already too little to work for.