| September 17, 2007
“An exercise in futility,” says patients. Well, with reimbursements being so low, what did you expect?
< Previous post A concierge physician to Stossel
Next post > Tattooing your eyeball
Learn more about the book
Buy the book:
The best of KevinMD.com.
Only on Facebook.
Comments are moderated before they are published. Please read the comment policy.
Reimbursement, if they even pay at all, is not enough to cover overhead, let alone pay me.
If my practice were substantially Medicaid, I’d go bankrupt.
There are clinics taking Medicaid in my area. They have various arrangements that allow them greater payment for Medicaid, sometimes even on a cost-plus basis. Or they get various government and private grants.
If they have ways of extracting higher payment, as far as I’m concerned, let them.
The story described, of the person saying she went to a doc’s office and then was told to leave, I see that sort of thing from time to time. The person is likely in some sort of Medicaid managed care plan. They are supposed to see certain doctors on-panel. I’m sure the patient said whatever the practice needed to hear to get scheduled. When paperwork was presented, though, that practice was non-network for them. We get that as well.
They say they’re not Medicaid when they really are, and pay cash. That’s fine, and I’d have sympathy for their plight. Problem is, Medicaid has a “look-back” of about six months in my state. What happens is they pay cash, then a few months later, they say “Oh, by the way, I have Medicaid”. They ask for a refund, and I’m back in the Medicaid mess.
For that reason, people who say they’re cash-pay, I check Medicaid eligibility anyway. Every few weeks, I find someone who has misrepresented his/her Medicaid status.
Another example of doctor arrogance. Why don’t you guys just open a practice for the rich folks, who are the people you really want to take care of? This is why a lot of you don’t see medical care as a right. Can you say THAT WOULDN”T BE PROFITABLE?!!!!Sure glad you are in the profession for the good of humanity…
Sad but true, that even cash is not as good as cash anymore. “The first question isn’t, ‘How can we help you?’ ” she said, “but, ‘What type of insurance do you have?’ ” Classic tear grabber line. But in reality there’s one thing medicine cannot do that your local mechanic can (and does); put a lien on your car and impound it until you pay. No pay and your car gets sold. In health care you cannot do that, so all hostage taking as it were must occur before services are rendered.
Waaaaaaaaaaah! You won’t treat me for free!
Try getting free rent from your landlord
Try getting free food from your grocer.
Try getting free gas from your service station.
How arrogant that doctors don’t want to go bankrupt.
Actually, if “rich folks” means rich elderly, it doesn’t help much, as Medicare is Medicare, whether a retired millionaire or a retired pauper. Pay is the same.
If the goal is dollars, the best patient demographic is young employed families.
The elderly patient described in the article should be Medicare.
Medicaid would be secondary coverage.
Are you a vet? Do you treat pets for free? Maybe health care for pets should be an absolute right so we can introduce government redulated, peticaid.
If we had the supply side restrictions on gas stations, grocers and landlords then perhaps the comment of getting “freebies” from them would work. Providers have a duty to provide healthcare and “do no harm” as part of the social contract that allows them to grossly restrict the supply of those that can enter the field to limit competition and ensure sky high after-expense compensation rates. Society has been getting the short end of the stick on this deal and it is about time people wake up and demand a level of responsibility from the providers commensurate with their privilege.
“Society has been getting the short end of the stick on this deal and it is about time people wake up and demand a level of responsibility from the providers commensurate with their privilege.”
Pretty words, but meaningless.
There is no “privilege” in medicine. If anything, it is the public that is privileged to have doctors to look after them. With 8 years in school, hundreds of thousands of dollars of debt to pay off, and another 3-6 years in residency working 80 hours a week for less than $50K a year?
Where is the privilege in that?
If society paid for doctors-to-be to attend school, and then paid them a reasonable wage for their work while a resident, then society would should have a say in how they’re treated as a collective.
Until that time, “society” can pay up or shut up. Being homo sapiens isn’t a guarantee of free health care, as much as the bleeding heart liberals in this country would like this.
You are not special. You are not a beautiful and unique snowflake.
Happy thoughts and pretty words don’t pay the electric bill or put food on the table. And it clearly is a matter not even being able to pay the bills, as you can read from the comments above.
If I was a doctor, or had aspirations of being one, I certainly wouldn’t accept medicare or medicaid, until the reimbursement rate problem is fixed. Don’t like it? Complain to your representatives.
You can demand responsibility all you want. You cannot force me into indentured servitude, or force me to finance the healthcare of others. I can always leave.
It is not irresponsible, personally, or socially, to refuse to provide service to an unlimited number of patients for whom providing that service results in a negative bottom line. On the contrary, risking the viability of my practice by continuing to see such patients is irresponsible, and does a disservice to those patients for whom reimbursement exceeds expenses, who would otherwise be left with one less provider, thereby driving the cost of care up as supply shrinks further.
What is irresponsible, if for a society, via it’s government, to impose price controls which inevitably increase costs, reduce supply, and adversely affect quality. (See “Medicaid”).
“supply side restrictions on gas stations”
We do – it’s called zoning.
I am a family doctor who is struggling to keep the door open and avoid becoming bankrupt. The main reason for this is poor payment for medicaid and medicare in my area. My family and I have no health insurance and are struggling to get by and pay the bills. A lot of people depend on the care I provide. Who is going to benefit when I close the door for good. I am afraid that this is soon going to happen because my family deserves to see me occasionlly and not live from paycheck to paycheck. I have a lot of sympathy for people who are struggling financially because I am one of them. Those of you who are always assumng that all physicians are rich need to rethink your position. Those of us who try to care for the rural, poor, and underserved certainly are not. So when you get ready to make that sarcastic remark about the doctor with his mansion and boat, remember those of us struggling to pay the bills and keep the door open.
Social contract? Doesn’t the scope of the disagreement between the thousands of interested parties suggest that there is no social contract? Social contract is just another means that people who want things free try to confiscate the property or work of others.
You have to pay into Medicare to be eligible for Medicare. This man is likely a foreign immigrant who never paid into Social Security or Medicare and is therefore not eligible for Medicare benefits.
From the article:
“You also have to factor in supply and demand,” said Hales. The general supply of doctors is dwindling as more reach retirement age and fewer graduate from medical school. Meanwhile, aging baby boomers feed a growing demand for care. In leaner times, “a doctor might not care so much about reimbursement so long as somebody is in the chair,” said Hales. But today, “we really rely on the good naturedness of our doctors,” he said. “
Conclusion: How do you tell when a Medicaid director is lying….when he opens his mouth.
Fewer graduating from medical school??
The number has been going up.
There’s going to be a bigger uptick soon, as there are new schools coming online as well.
New medical schools comming? Share this information with us.
http://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_StatesThe number of medical schools, currently 126, hasn’t meaningfully changed since I was applying in 1985.
Have the class sizes increased?
…ask yourself why did you go into medicine? As far as “keeping the doors open”, guess what MDs? The days of private practice are gone. The days of mass practice are here. Face reality…why is it that doctors want to keep the old ways where they were treated like self important Gods? Guess what ladies and gentlemen, those days are gone and they ain’t comin/ back…
Actually, the most desireable patient is not a young working person with insurance. Most likely, this person will be with an HMO and reimbursement often is at or below Medicare rates. The most desireable patient now is the illegal immigrant who pays cash. My advice is that if you can’t afford insurance, avoid Medicaid and pay cash. You will get seen immediately and get excellant care.
Oregon, as one example, increased its class size, and added a branch campus in Eugene.
The osteopathic schools are expanding like crazy. New schools and branches of established schools.
Google “Medical School Expansion” or a similar phrase, and you’ll see the plans in place all over the country.
I totally believe in kharma, and God forbid, someday you are struggling financially for REAL, Not just complaining about affording your next vacation or a bigger house or nicer car, but really hurting and needing medical help and can’t find a Dr. who accepts what insurance you have at the time. I do not need to wish it upon you, what comes around, goes around. Good luck with that!!!
Past 6 Months
site by Out:think Group