So, you want to pay your doctor extra?

Well, that’s illegal for Medicare and Medicaid patients:

She was surprised that it is illegal to pay the difference between what we charge and what insurance collects. Here is a potential Medicaid patient willing to pay her fair share, and the system won’t allow it. Why? I have no idea why. Both patient and doctor win. Patient gets access, Doctor gets their fair fee.

Comments

Anonymous
It is the difference between government-mandated price controls, which we have now twith Medicare and Medicaid, and market pricing.
Price controls reduce supply, every time.
Anonymous
From the access perspective, Medicaid is simple: most doctors cannot/will not deal with Medicaid.
Medicare is a much tougher decision. A few physicians are opting out. Many doctors are limiting their losses by refusing to see new Medicare patients. one or two years of 10% reimbursemnet cuts, and you will see a hemorrhage of doctors coerced into opting out.
Ed Sodaro MD
Anonymous
“Most doctors will not accept Medicaid”?
Because they discriminate against the poor, who need medical care.
Anonymous
Please! It is one thing to be charitable, another to be an indentured servant. You must have been a plantation owner in a former life. Absolutely un-American.
The Happy Hospitalist
If you believe your physician should accept a payment that is less than his/her overhead (ie medicaid), then you need an education in economics. It is nothing to do with discrimination and everything to do with paying their bills.
Discrimination, nice uneducated call.
If you want universal free health care for all, look only to medicaid and you’ll have everyone covered, but no one to see you.
You can’t call it discrimination if everyone has coverage but lacks access. That’s called universal coverage in a nutshell, and medicaid is the glowing example.
Some state medicaid programs pay your primary care doc the striking fee of $20 for a 1/2 hour visit. You know what that comes out to after over head? You guessed it, the equivalent of $40,000 a year salary. That’s less than a pizza delivery driver with good tips. I should know, because that’s how i paid my way through undergrad.
You have no more of a right to use your doc for substandard fee’s than I have the right to steal groceries, or driving off from a gas station without paying. It’s stealing. That’s the fee medicaid programs are willing to pay. Wages not even high enough to pay overhead. That’s the same as losing money and is equivalent to stealing. So discriminate away primary care and force a change in the system. Keep voting with your pocket books until reimbursment is in line with a competitive wage.
Anonymous
>>”Because they discriminate against the poor, who need medical care.”
No, because like everyone else, they won’t work without being paid.
Doctors might discriminate against those who think they are entitled to others’ labor without paying for it.
Got a problem with that?
Anonymous
Do I hear the “White elitist” organization out there, preaching for discrimination against the poor?
Isn’t it nice to be anonymous??
Anonymous
“That’s less than a pizza delivery driver with good tips. I should know, because that’s how i paid my way through undergrad.”
So climb in your car and start delivering more pizza. You can earn another $40,000 and gain spiritual points with the Lord, for taking care of the poor.
Are there no Christians on this board?
Anonymous
“Are there no Christians on this board?”
No. They all went into investment banking or law. Most of us immigrant doctors allowed in to fill the void left by inadequate Medicaid compensation are Muslim or Hindu.
Anonymous
Part of the problem is that in many states, Medicaid is so difficult for adults to qualify for that every adult Medicaid patient is an absolute “Trainwreck”. (Not so with kids – they just have the misfortune of being born to poor parents.) When I was in private practice, I started out feeling that I should take my fair share of Medicaid patients. My partners warned me – they capped their Medicaid caseload at a fairly low number. My typical Medicaid patient was either a chronic pain patient with multiple psychiatric issues and/or substance abuse issues, or diabetic and hypertensive with seizure disorder/post-head injury…. You get the picture. These folks truly need individualized care, and I enjoyed trying to help them. But I soon had to put a cap on the number I was willing to see, because I was going broke trying to meet their very complex needs for a token fee. I think it might be better for physicians to be able to see these folks and just write off the fair market value of their care on taxes as a charitable contribution. Even then, you could not see too many or you would not have enough income to qualify for any tax deductions..
Anonymous
“Are there no Christians on this board?”
No – they all went out of business due to Medicaid reimbursements, and their computers were repossessed.
Anonymous
Christians? Please.
Since when is it the privilege of a “Christian” to demand the wares and labors of others without payment? I just love to hear the self-righteous dress up confiscation and fraud under color of public policy as a virtue, and then better yet, presume to disparage those who object to that scam as “un-Christian.”
Who knows if there are Christians reading and commenting here? Should that matter? And who appointed you to judge that those who aren’t in agreement with your ethic of the thief and the parasite as being “un-Christian?”
Mote in thine neighbor’s eye?
Anonymous
Most of the Medicaid patients in my practice are the parents and family members of the foreign M.D.’s that I work with. I would see them for free anyway, so it doesn’t matter that they have Medicaid. The few other Medicaid patients I have usually just come in for their Botox injections.
Anonymous
“Thief and parasite?”
That’s how you regard a Medicaid or Medicare patient? Those people are in need, and they are not the ones who set the rates–our elected officials are involved in that.
And Medicare patients are our grandparents who worked their lives for that SS and Medicare, and to call them “thiefs and parasites” is dissing them.
Number one, these people need medical, and those on Medicaid can not get it any other way because they can’t work, though I’m sure some people here would prefer to float them out to sea on an ice floe.
Number two, focus on the twits who set the payment schedules, and criticize them. They’re the idiots who decide who get paid what.
And while price controls may reduce supply every time, market pricing reduces accessibility.
Metta, Rjaye.
Anonymous
Thief and parasite.
The government, wishing to sell the illusion to its electors that it is providing “benefits” from the taxes it collects bestows “privieges” on certain members of that society–people I can tell you are a mixed bag of the genuinely needy and unfortunately also the genuinely parasitic–to “buy” (and that is really stretching the notion of purchasing) at extremely low fixed rates the services of private sellers. The seller gets to decide to take it or leave it, no negotiations. Worse, the payment often never arrives, usually doesn’t even cover the cost of the services when it does, and often arrives six months after the services are delivered.
Suppose I decide to hire you (play along here, suppose you are smart enough not to think it is your right to demand charity of others). The going rate for your labor is $12.00 hourly. But I am with Medicad, so I offer you $4.00 instead. You will have to buy your work clothes and of course have a car and pay for gas to get to work. That expense is yours to cover. Payday is normally every two weeks; but you will get your pay six months from now. Now I know you are a working person with bills to pay and all, but those are my terms, no negotiations. Do you still want work? You know, the people who will benefit from your labor are really needy. Sometimes they can be a little demanding, too. They don’t much care how much I’m going to pay you–they have insurance, you see–but they really do expect you to work for them as if I were paying you the $12.00 per hour you are not going to get. Oh, and sorry, all your bills still have to be paid on time and in full, so I guess that means a second job for you. Perhaps your other employer won’t insist on your being as much a “Christian” as I might.
Not to burst your bubble, but charity begins with yourself. If you really think people deserve access to cheap care, then give your money to a charity clinic with an approved fund that accepts donations. Better yet, offer to volunteer at a private office if the owner will provide the value of the wages you would get as in kind services to needy patients. But your whining on this thread is the whining of the parasite, the person who thinks it is the duty of others to be doing the giving.
Anonymous
“Most of the Medicaid patients in my practice are the parents and family members of the foreign M.D.’s that I work with. I would see them for free anyway”
That’s one of the more curious comments I’ve seen on this blog recently.
So you have no problem with dispensing free care to relatives of associates who could easily afford to pay, but curse lowering your fees for those on government programs who (generally) cannot.
Sound like this is less about money and more about the desire for control over your business?
Anonymous
Here I thought all the free care I have given was being “christian”. I guess just not “christian enough for an anon who most likely has not volunterred for anything since the turn of the century. Anon, what is obvious is that you have never run a practice. I can’t give unreimbursed/undereimbursed care to the point of bankruptcy. Go back 10-15 threads on this site, you will read about a PCP who just did that….he is going out of business. If the 10% mwdicare cut is enforced, those effected will not be the senators. They will be our seniors.
The Happy Hospitalist
it is amazing some would suggest that I should deliver pizza’s instead of see Medicaid patients. In effect that’s what medical students are doing. But instead of entering the pizza delivery business, they are entering every field of medicine except primary care?
The reimbursment system of medicine used to allow for the subsidizing of “free medical care”, of which medicaid is basically reimbursing these days (and soon to be medicare), by allowing physicians to earn more from those who were able to pay more.
When medicare’s fantasy system of RVU and fixed pots entered, private insurance followed their lead and removed all notion of a subsidy for the poor.
What you have are poorly paying reimbursment systems across the board, for primary care, which through any idea of free or subsidized care. Now the expectation is for everybody to pay.
How do yo fix it? Balanced billing or Cash. If you want to get free care, you will have to have it subsidized by those willing to pay more. Right now, that’s illegal. And it’s illegal to charge your poor anonymoushumbled asses less than medicare/medicaid, because then they would want that reduced rate and everyone would bankrupt.
So bitch away, but point your finger towards Washington, who controls your destiny. Your primary care doctor is a victim of the system, just as you are.
The Happy Hospitalist
If anyone is proposing that primary care SHOULD be mandated to see medicaid (and soon the be medicare) for fee schedules that are not sustainable, then I propose, I should get my $125 in groceries, another life sustaining need, even more so, for $20. And I should have unlimited access to this program. I should get emergency tbone steaks for my family barbeque for $1 a pound at the 24 grocery store (the ER) and I should get an unlimited amount.
This is medicaid. To a big degree, this is Medicare too, and alot of health care insurance plans. Nothing should be free. Medicare, Medicaid, HMO. None of it should ever be free. Ever. There should always be a cost to the patient for utilizing the service. Always, this is overt market determined rationing, which is necessary to stem the overutilization of the system.
It is human nature to take advantage of others based on price. If it costs you nothing, you will consume till the very end. That includes Medicaid, Medicare, HMO, managed care, and all insurance plans. Instead of insuring against catastrophy, it is supplanting a normal cost of living. Health care is a cost of living, like your groceries, utilities, education, and taxes.
It is no wonder why primary care is leaving the field in droves, not to delivery pizza, but to be procedural based doctors, or not entering the field of medicine, period. They will not work for free, ever. Just like you won’t.
Being Chrisitian doesn’t mean being a slave. It doesnt’ mean working for free. I don’t expect to get my groceries for free. If you think food stamps are the answer, (the medicaid equivalent then use those food stamps with actual market pricing. That 1/2 hour visit of free care should pay at least 125$, not $20. Do you think your grocery store only gets 10 cents on the dollar for their food stamps? The problem is the government won’t allow you to subsidize your poor patients with a reduced fee schedule with balanced billing of those who are able to pay. That is illegal. Blame your Congressman, not your doctor.
Slavery was abolished, in case you haven’t hear. Primary care is cutting the shackels of their substandardlabor contracts by leaving the field in droves, or refusing to see you, Mr Medicaid, Mrs Medicare, and HMO, and freeing themselves from all insurance. They are going to cash only, fee for service. Pay or don’t pay, It’s your call.
You get what you pay for, you always will. Accept the results of your vote, or contact your Congressman. Don’t blame your primary care doctor who is being squeezed by a ridiculous revenue model, which is not based on reality.
KoKo
Well said. Mehta.
Anonymous
Is there a “Mitzvah Doc” on this site?
Anonymous
” Anonymous said…
“Are there no Christians on this board?”
No. They all went into investment banking or law. Most of us immigrant doctors allowed in to fill the void left by inadequate Medicaid compensation are Muslim or Hindu.
9:26 PM”
Thank the good Lord for that, Sir/Madam.
Anonymous
“Anonymous said…
Christians? Please.
Since when is it the privilege of a “Christian” to demand the wares and labors of others without payment?”
Why twist the words of your Savior? Have you no shame?
Anonymous
>>”Why twist the words of your Savior? Have you no shame?”
That was my point to you, but you must be a little dense.
The apostles paid rent for the upper room. They also paid for the loaves and fishes.
You seem to think an ethic to show mercy for the poor and unfortunate (which, my dear benighted friend, is a virtue to more than Christians, if you must know), can be applied in the reverse and by proxy. The beatitude, the mitzvah, the pillar, is a message to those with the resource to give to consider the needy, not a license for the needy to seize or take, nor an invitation for the hypocrite to prescribe to others what they will not do themselves.
No one has a right to someone else’s labor without just payment for that labor. Christianity does not differ on that either.
Anonymous
“Don’t blame your primary care doctor who is being squeezed by a ridiculous revenue model, which is not based on reality.”
No one is “blaming” him, but why does he keep accepting the govt.’s money if he’s just going to complain about having to act in accordance with its rules?
Anonymous
“No one has a right to someone else’s labor without just payment for that labor.”
Amen.
Payne Hertz
Speaking of “thieves and parasites,” why does anyone have to go to a doctor at all? Oh, that’s right, the government you hate so much enforces the monopoly you have over medications which are only available by prescription, and enforces the monopoly drug companies have over those medications, some of which used to be available without a prescription. So if I need a refill of a medication I’ve been taking for years, I have to go to you for approval once a month, hand over more money for five minutes worth of abuse, humiliation and condescension, take a bunch of expensive tests that I’ve already had so you can CYA and make a little money from the kickbacks, and then pay a king’s ransom to the drug company to get a med that would cost 1/30th as much if there was truly a free market in medicine. Most people I know with chronic pain who have to pay out of pocket for their medical care lay out tens of thousands of dollars on useless tests and procedures and “doctor shopping” until they can find someone who will “treat their pain” (aka, do something besides treat them like drug addicts and shuffle them out the door with the bill in hand). Once you’ve found this rare creature, you then get to lay out around $1,000 a month for doctor visists and what is usually a substandard amount of medication, based not on your need for pain relief but on your doctor’s comfort zone in prescribing.
Then the government asks you to pay for this privilege by seeing ahandful of poor patients at a reduced rate, and you balk. So yeah, let’s bring back the free market you doctors say you want so badly, and go back to the days when you could buy drugs without a prescription, and doctors had to travel 30 miles to get paid with chickens and goats. I’ll be happy to wave hello to you as I walk out of the pharmacy with my $15 bottle of laudanum in hand. As the old saying goes, be careful what you ask for, you might get what you deserve.
Anonymous
“”No one has a right to someone else’s labor without just payment for that labor.”
Amen.
# posted by Anonymous : 12:07 PM”
Yikes, that’s a good one. I can remember all the little premeds who used to “offer their services” free of charge at our hospital, so the little SUCKUPS could write on their resumes that they were interested in patient care.
Now those little pissheads want to be paid.
The Happy Hospitalist
PH, your ignorance of the economics of the situation is quite obvious.
Asking me, a doc to give you 11 refills on you morphine or oxycontin or hydrocodone is like calling the DEA myself, and turning myself in for trafficking in a controlled substance.
You sound like you need more than pain medication to help you. I hope you find the answers, because what you know you need is not what any doctor will ever be able to offer. Good luck in your journey.
The Happy Hospitalist
“No one is “blaming” him, but why does he keep accepting the govt.’s money if he’s just going to complain about having to act in accordance with its rules?”
The short answer, is they aren’t. More and more primary care docs are either walking away for the system or simply not entering the primary care field. There in lies the answer to your shortage.
Wait for medicare’s 40% cuts over the next five years to take hold. You’ll here primary care docs saying. “Medicare? are you serious, I stopped taking that years ago, and it was the best decision of my life.” Many are already doing so now and one need only look at medicaid to understand the trend.
Payne Hertz
Hospitalist, I don’t see where I asked you for anything, let alone 11 refills of narcotics. I don’t even take narcotics. I realize it is easier to lump all chronic pain patients together into such an obviously inflated caricature for easy disposal rather than to think critically, but if this is the attitude you take with your patients then be grateful, Medicaid is already paying you more than you’re worth.
Anonymous
A question. So what a someone who is over 70 is supposed to do? What are you going to do when you are in medicare age? Does buying medicare supplement help?
This is not a tricky or sarcastic question, just an honest request for information from a younger baby boomer whose parents are elderly and on medicare and who herself is going to be on medicare at some point (if it still exists then).
Anonymous
“A question. So what a someone who is over 70 is supposed to do? What are you going to do when you are in medicare age? Does buying medicare supplement help?”
I think these are very good questions that affect all of us, including physicians.
One answer is to keep working and your private insurance. Many of my patients have done this. This is not the real solution however as most private insurance simply follows Medicare rates nowadays. Supplements only pay up to the 20% of Medicare’s monopoly “allowable” not covered by Medicare directly. In general, providers may charge not a penny more or less than the rate set by Medicare. So if you want a “premium” experience with leather chairs, Starbucks coffee, and real face time with your physician, this is not going to happen within the confines of the present system. That is why most offices resemble a bus terminal nowadays.
I believe that as the situation and access worsens, the law will have to be changed to allow Medicare beneficiaries to use their benefit as partial payment with private insurance, health care savings accounts, or private funds paying the difference so that you may see whomever you care to without having to worry that they do not accept Medicare. That would be the American way.
Believe me that physicians should be worried about how they themselves will obtain medical care in the future. We are all patients someday.
The Happy Hospitalist
PH, like I said, good like on your journey for your answers. I stand by my statements.
Anonymous
“the laborer is worthy of his hire”
—Jesus Christ
Medicaid and Medicare are not charity. A physician chosing to treat a poor patient for free or a reduced reimbursment is charity. Those programs confiscate money from the public and hire the doc to provide the care so the political establishment can buy the loyalty of voters. There is no moral import to accepting or rejecting the wage.
The richest person in town, if they are over 65, gets the same enforced discount as the poorest. It has naught to do with charity. Over 50% of the wealth of the nation is in the hands of those over 65. Even many Medicaid enrolless are the unaknowledged offspring of men making very good money, some dealing drugs, who have offloaded the responsibility for the care and feeding of their offspring onto a gullible public. A great many others on Medicaid are the prosperous elderly who gave their substantial assets to their children while sending their healthcare and nursing home bills to other peoples children.
Where there is coercion, there is no charity.