| September 14, 2005
“Financial screening trumped medical triage.”
Findings from a study where those with private insurance were offered faster follow-up care than those with Medicaid.
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is this a bad thing? what it shows is that doctors are, like everyone else, responsive to economic incentives. The problem, if there is one, is that consumers are removed from the bargaining. Consumers must pay more of the healthcare bills so that they can have more control over their doctors.
This isn’t news. Medicaid is a low, sometimes no-dollar reimbursement plan that many practices will not take. Those that do often end up with packed schedules and longer waits for appointments. So goes the world.
I have and do accept Medicaid. Believe me, that is a status over which one must keep a close watch, as seeing too large a percentage of Medicaid patients will sink your practice. We don’t discriminate by insurers, and no ethical doctor should, but I do not think it unreasonable to close your practice to new Medicaid patients when the numbers become too great. There is only so much “charity” the state can impose on private practices before the demands become unreasonable.
Medicare and Medicaid do use financial incentives to drive practice behaviors. So then it should come as no surprise that incentives will achieve an outcome.
The only surprise is the incredulity of the public that incentives would alter our behavior.
Just imagine the effect of a Gassoline-aid sponsored government program. Would the gas-aid card bearer offering $1.50 a gallon induce any station to fill their tank. Would any gas station enroll Gas-aid customers, such that once enrolled, they would be entitled to all the gas they want at the government stipulated rate?
The shocker is not that some medicare/medicaid patients get less preferential care sometimes, but that in an open marketplace, they get any care at all.
I once worked in an office where a managed-care plan was accepted that paid about one-sixth the going rate of $180 or so for a complete ophthalmological examination and fitting for eyeglasses. The posted rate was $30. Now most of the patients enrolled were on public assistance, and in that group, the percentage of scheduled but missed appointments–no shows–was 40%. Then there were the claims denials, which further eroded the receipts for work done, such that we collected about $10 for every scheduled appointment made by patients on that plan. Now that is a bad plan, and accepting that plan is terrible judgment for a practice owner (not my decision, and I am glad not to be working there any more).
Unfortunately, this kind of performance is pretty typical for Medicaid managed care. It should be no surprise that no one wants to see these patients.
I especially like that the article suggests that medicaid patients just “lie” in order to recieve their appointment.
The “lie” strategy usually backfires. Most offices check insurance before the patient is taken in. Showing up with a Medicaid card when that plan is not accepted will usually result in the patient being told that they will have to pay for the visit in cash, in full and at the time of the visit. Having a record of the name of another plan noted in the computer records from the time the appointment was made doesn’t help matters, either.
It was bad advice, IMO.
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