Guest guest Posted August 30, 2007 Report Share Posted August 30, 2007 What a great topic. I am torn on this issue too. I am like Matt and think that Maine-care is actually paying pretty well, better than NJ Medicaid and of course Maine BCBS is paying far better than NJ BCBS also. I also take Medicaid but limit the numbers as an obligation I feel to our society to help care for the needy. Afterall, Medicaid is an insurance program only for medically needy, not just poor. It has been expanded to include healthy children. I get mad at the fraud and the “patients” committing the fraud but still, there are some good, unfortunate people on Medicaid that I think deserve good medical care and of course I give the best ;^D. But, I also get mad when I hear people say they could solve the “uninsured” crisis with the same monies already covering Medicaid and doing it differently. This is highly misguided as in NJ, at least in a private doctors office, they really pay nothing and we are giving away our services. In NYS, you can’t collect payment, ever. So much of the “Medicaid care” is never paid for. So how can you take the same monies and cover more lives when they aren’t covering the lives they say they are anyway. Clinics get paid much better. So part of me says, just let all the Medicaid patients go to the clinics and receive suboptimal care but at least the clinics get paid adequately. And part of me says, that’s not fair to the patient. Many of mine are from families with both parents working, just dirt poor and no insurance through the job. Some are scum bags and I try to get rid of them (sorry but it’s the truth-see them written up in the police blotter of the local paper). So part of me believe Lou is correct, revolution creates faster changes than evolution and as long as we play along and take it, the less likely things are going to change. Especially when our political representatives think Medicaid actually works and some well meaning doctors too. But the other part of me says that it is just wrong to deny care to people because they are stuck on this lousy plan. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2007 Report Share Posted August 31, 2007 freebie community clinics w malpractice immunity? dead zone report> > > > reporting to you live form a dead zone> > on the local news this am:> 1. the mean household income in the USa has risen to $48,000 -1.6% over> X> time I forget> the median household incme in Maine has FALLEN 1.3% to $43,000.> > 2.They mention the commonwealth study wherein maine has teh fifth lowest> number by percetn of uninsured in teh country . Yeah but the reason few> people are uninsured is becasue Maine hands out Mainecare plastic cards> to> anyone . and they get "insurance" funded on the backs of docs.> I got two new families this week On e maine care I got 32.00 for 86.00> worth of wrok The other Blue CRoss I will get 86.00 for 86.00 worth of> work.> Grr.> > Come the revolution....> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2007 Report Share Posted August 31, 2007 RE cutting off pts in need. I disagree. I need to live too. Let state (US by the way) pay the "providers of care" a reasonable fee. In my area, I cannot even order an X-ray or CT scan for Medicaid pt if not the "primary." One doc in Kentucky recently reported that he got paid $12 after 1 year of fighting with Medicaid in PA for admission of child in dehydration. I can no longer afford to subsidize "pts in need" if not even reimbursed 30 cents on dollar Dr Wible -- If I recall, you had your "fits and starts" surviving in earlier practice. Please give me the courtesy of surviving. If you can work out of a "one room schoolhouse" taking care of pts while you proselytize around the country, good for you. But others of us have to survive too. Please understand that in my area of the country, recent stats show that PA has 10% of kids without insurance, and 10% of adults. Hospitals in my area are running primary care offices as managers, then going to the state when they're "loosing money" as nonprofits, as well as retrofitting their ERs with mid-levels to do mediocre care. My state also has one of the highest malpractice burdens; I paid over $14K in malpractice fees this past fiscal year. I know I sound like I'm whining but here's the basic truth: If you're giving it away for free, you'll always find takers. I'm just not able to work for "free" anymore. I am pleased for that she can see 30% of her pts for "free," and you too. Good for you. But not me. My practice is now growing, perhaps more like a traditional business than yours. Yours may be more "one room schoolhouse" but I'll just have to bring home alittle more money -- and spend alittle too. Respectfully, and comments welcome... from the Keystone state, land of high malpractice insurance and high uninsureds (who don't want to pay, please let me assure you). Matt Levin, MD solo since Dec 2004 residency FP 1988 SOAPWare user since 1997 dead zone report> > > > > > > > reporting to you live form a dead zone> > > > on the local news this am:> > 1. the mean household income in the USa has risen to $48,000 -1.6% > over> > X> > time I forget> > the median household incme in Maine has FALLEN 1.3% to $43,000.> > > > 2.They mention the commonwealth study wherein maine has teh fifth > lowest> > number by percetn of uninsured in teh country . Yeah but the > reason few> > people are uninsured is becasue Maine hands out Mainecare plastic > cards> > to> > anyone . and they get "insurance" funded on the backs of docs.> > I got two new families this week On e maine care I got 32.00 for > 86.00> > worth of wrok The other Blue CRoss I will get 86.00 for 86.00 > worth of> > work.> > Grr.> > > > Come the revolution....> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2007 Report Share Posted August 31, 2007 Matt: It put it all into perspective when the female Medicaid patient came to my office in her Lincoln Navigator and interupted the visit on her cell phone, but couldn't manage the $2 copay for medicaid. Also, I took care of a brittle insulin diabetic in the ICU for 7 days. The first night for two hours. Total compensation by medicaid 8 months later $210, $30 at a time over two months after repeated phone calls to the state and multiple resubmissions through the clearinhouse. We wrote off over $1000 in real charges. Patient has no-showed ever since discharge 8 months ago. We give free care to about 3-5% of our patients. We are nearing solvency so we may increase that part of our practice. But with our student loans and mortgage requiring $30-60,000 a year to cover, a stable income was one of our first priorities. As we have cut those expenses by paying off debt, the charity care becomes easier. [Practiceimprovemen t1] dead zone report> > > > > > > > reporting to you live form a dead zone> > > > on the local news this am:> > 1. the mean household income in the USa has risen to $48,000 -1.6% > over> > X> > time I forget> > the median household incme in Maine has FALLEN 1.3% to $43,000.> > > > 2.They mention the commonwealth study wherein maine has teh fifth > lowest> > number by percetn of uninsured in teh country . Yeah but the > reason few> > people are uninsured is becasue Maine hands out Mainecare plastic > cards> > to> > anyone . and they get "insurance" funded on the backs of docs.> > I got two new families this week On e maine care I got 32.00 for > 86.00> > worth of wrok The other Blue CRoss I will get 86.00 for 86.00 > worth of> > work.> > Grr.> > > > Come the revolution.. ..> >> Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2007 Report Share Posted August 31, 2007 Agreed, sadly When I can write off bad debt against taxes (Gordon, are you listening????) then maybe I can do this. Also, add onto everything the "uncopyable paper mandate for ALL Medicaid scripts" (by the way, I started doing this ANYWAY 4 months ago ON MY OWN), I find that taking care of this population has TOO MANY UNCOMPENSATED CHALLENGES. Open more community health clinics NO MALPRACTICE BURDEN and I'll do a "shift a week." M [Practiceimprovemen t1] dead zone report> > > > > > > > reporting to you live form a dead zone> > > > on the local news this am:> > 1. the mean household income in the USa has risen to $48,000 -1.6% > over> > X> > time I forget> > the median household incme in Maine has FALLEN 1.3% to $43,000.> > > > 2.They mention the commonwealth study wherein maine has teh fifth > lowest> > number by percetn of uninsured in teh country . Yeah but the > reason few> > people are uninsured is becasue Maine hands out Mainecare plastic > cards> > to> > anyone . and they get "insurance" funded on the backs of docs.> > I got two new families this week On e maine care I got 32.00 for > 86.00> > worth of wrok The other Blue CRoss I will get 86.00 for 86.00 > worth of> > work.> > Grr.> > > > Come the revolution.. ..> >> Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 RE Optout of Medicaid. YES!! I don't take any more Medicaid pts. Much simpler than opting out of Medicare (no way would do that here! Medicare actually pays fairly well, about $79 for a 99214). Just notify the 1 of the 3 Medicaid HMOs I won't take anymore pts. If I want to dump those on it (no, didn't do that), I could do this with 90 days notice. Did this early July when my volumes crossed 30 pts a week AND had 2 MA pts no show x 2 in a row -- fed up. Matt Levin, MD dead zone report> > > > > > > > > > > > > > > > reporting to you live form a dead zone> > > > > > > > on the local news this am:> > > > 1. the mean household income in the USa has risen to $48,000 -> 1.6% > > > over> > > > X> > > > time I forget> > > > the median household incme in Maine has FALLEN 1.3% to > $43,000.> > > > > > > > 2.They mention the commonwealth study wherein maine has teh > fifth > > > lowest> > > > number by percetn of uninsured in teh country . Yeah but the > > > reason few> > > > people are uninsured is becasue Maine hands out Mainecare > plastic > > > cards> > > > to> > > > anyone . and they get "insurance" funded on the backs of docs.> > > > I got two new families this week On e maine care I got 32.00 > for > > > 86.00> > > > worth of wrok The other Blue CRoss I will get 86.00 for 86.00 > > > worth of> > > > work.> > > > Grr.> > > > > > > > Come the revolution....> > > >> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 Pamela, please don't include Central Ohio in your list of dead zones. Columbus is the 16th largest city in the US and is the headquarters for The Limited Brands, DSW, Nationwide, Cardinal Health, Abercrombie. It is the 2nd largest business incubator. People generally have decent insurance. I am in Central Ohio and have a bustling practice. I am in an area where no one even asks if I take Medicaid. The only Medicaid I pts I have are those who have it secondary to medicare. I do see a fair number of self pay patients who get a 50% discount on my fees (for paying at the time of service to get around insurance contract issues) Brock is in a rural area, albeit one that has some patients with good jobs and insurance. The problem is he is in a hospital supported practice that brought him in to take care of their population... Uninsured and medicaid patients. His experience is definitely not the norm here, although there is a little strip of family practices on the west side of town ( being outside of town on the west side) and another on the east side, that focus on medicaid patients. These practices see 60 pts a day per doctor in a remarkably assembly line like way. They also make a bundle and have patients trained to like their 2 minute visit. There is no way I could do that, I would lose my mind and my patients wouldn't tolerate it. Get a sneak peek of the all-new AOL.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 RE Dead zone and practice success Depends on lots of things... Need in community for new docs. Name recognition. Older docs nearer retirement age. Dissatisfaction w current med community. C'mon Pam -- you're a grown up... think about who cuts your hair, where you buy groceries, the BAD word of COMPETITION, supply and demand. Matt in Western PA FP solo since Dec 2004 20 yrs reidency trained Re: dead zone report The dead zone thing is very strange to me as some folks inthe same general area can have such different experiences.Must be many more factors at play than meet they eye.Pt panel, doctor personality/skill, supportive (or not)community could be a few. A guess the right mix couldmake a successful practice even in a lower reimbursement,higher malpractice "dead zone"....Thanks for the correction! I thought reimbursement in central Ohio was 1/3 of Eugene, Oregon levels. Maybe these are justrural medicaid numbers? hmmm....Pamela>> Pamela, please don't include Central Ohio in your list of dead zones. > Columbus is the 16th largest city in the US and is the headquarters for The > Limited Brands, DSW, Nationwide, Cardinal Health, Abercrombie. It is the 2nd > largest business incubator. People generally have decent insurance. I am in > Central Ohio and have a bustling practice. I am in an area where no one even asks > if I take Medicaid. The only Medicaid I pts I have are those who have it > secondary to medicare. I do see a fair number of self pay patients who get a 50% > discount on my fees (for paying at the time of service to get around > insurance contract issues)> > Brock is in a rural area, albeit one that has some patients with good > jobs and insurance. The problem is he is in a hospital supported practice that > brought him in to take care of their population... Uninsured and medicaid > patients. His experience is definitely not the norm here, although there is > a little strip of family practices on the west side of town ( being > outside of town on the west side) and another on the east side, that focus on > medicaid patients. These practices see 60 pts a day per doctor in a remarkably > assembly line like way. They also make a bundle and have patients trained to > like their 2 minute visit. There is no way I could do that, I would lose my > mind and my patients wouldn't tolerate it. > > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2007 Report Share Posted September 2, 2007 I have been following this discussion with interest and am once again reminded of how bad the system is. Financial sustainability is obviously an important aspect of any practice and it amazes me that primary care is funded so poorly that even efficient practices are having a tough time making ends meet. Some areas are worse than others, some practices are better at the coding game (which has no impact patient quality) than others, some practices increase procedures (many times with ?medical benefit) to make ends meet, some practices are subsidized by hospitals/grants/etc. But the fact remains primary care is financially in a tailspin. The first few IMP cohorts have proven that we provide better care. This should result in overall savings. Hopefully, Gordon and/or others will be able to use these results to leverage the financial changes necessary to once again make primary care a financially viable career choice. It should not matter whether you live in Ohio or Oregon or Maine or Mississippi, you should be able to provide great primary care without worrying if you can still feed your family. Last night I spoke to a good friend of mine who is an anesthesiologist who only does OB anesthesia. He makes 3 times what I do and only works 10 days a month. I am not saying that he should be paid less, but how is giving epidurals financially more important to insurances than what we do? Pay equity is all I ask for. After all, primary care docs are the only ones that actually decrease the total cost of medicine. Everyone else increases the cost. Things can’t change soon enough…. Re: Re: dead zone report RE Dead zone and practice success Depends on lots of things... Need in community for new docs. Name recognition. Older docs nearer retirement age. Dissatisfaction w current med community. C'mon Pam -- you're a grown up... think about who cuts your hair, where you buy groceries, the BAD word of COMPETITION, supply and demand. Matt in Western PA FP solo since Dec 2004 20 yrs reidency trained Re: dead zone report The dead zone thing is very strange to me as some folks in the same general area can have such different experiences. Must be many more factors at play than meet they eye. Pt panel, doctor personality/skill, supportive (or not) community could be a few. A guess the right mix could make a successful practice even in a lower reimbursement, higher malpractice " dead zone " .... Thanks for the correction! I thought reimbursement in central Ohio was 1/3 of Eugene, Oregon levels. Maybe these are just rural medicaid numbers? hmmm.... Pamela > > Pamela, please don't include Central Ohio in your list of dead zones. > Columbus is the 16th largest city in the US and is the headquarters for The > Limited Brands, DSW, Nationwide, Cardinal Health, Abercrombie. It is the 2nd > largest business incubator. People generally have decent insurance. I am in > Central Ohio and have a bustling practice. I am in an area where no one even asks > if I take Medicaid. The only Medicaid I pts I have are those who have it > secondary to medicare. I do see a fair number of self pay patients who get a 50% > discount on my fees (for paying at the time of service to get around > insurance contract issues) > > Brock is in a rural area, albeit one that has some patients with good > jobs and insurance. The problem is he is in a hospital supported practice that > brought him in to take care of their population... Uninsured and medicaid > patients. His experience is definitely not the norm here, although there is > a little strip of family practices on the west side of town ( being > outside of town on the west side) and another on the east side, that focus on > medicaid patients. These practices see 60 pts a day per doctor in a remarkably > assembly line like way. They also make a bundle and have patients trained to > like their 2 minute visit. There is no way I could do that, I would lose my > mind and my patients wouldn't tolerate it. > > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2007 Report Share Posted September 2, 2007 well said (well typed!) I will say it . that i think the anesthesiologist probably should be paid less. Less than 3 x what you make for 1/2 the number of dys of work I sat next to the specilaists in med school They are no smarter than I. .. What did you friedn think o f primary care's situation?Do specilaist give a hoot? Or they have so much of their own trouble like with malpractice rates? IT would be nice to have specialist's support... I spoke to my eye doc the other day Our Maine medical assocaiation mtg is coming this week she used to be presdient.. she said she has nothing to say anymore becasue nothing works . Re: Re: dead zone report RE Dead zone and practice success Depends on lots of things... Need in community for new docs. Name recognition. Older docs nearer retirement age. Dissatisfaction w current med community. C'mon Pam -- you're a grown up... think about who cuts your hair, where you buy groceries, the BAD word of COMPETITION, supply and demand. Matt in Western PA FP solo since Dec 2004 20 yrs reidency trained Re: dead zone report The dead zone thing is very strange to me as some folks in the same general area can have such different experiences. Must be many more factors at play than meet they eye. Pt panel, doctor personality/skill, supportive (or not) community could be a few. A guess the right mix could make a successful practice even in a lower reimbursement, higher malpractice " dead zone " .... Thanks for the correction! I thought reimbursement in central Ohio was 1/3 of Eugene, Oregon levels. Maybe these are just rural medicaid numbers? hmmm.... Pamela > > Pamela, please don't include Central Ohio in your list of dead zones. > Columbus is the 16th largest city in the US and is the headquarters for The > Limited Brands, DSW, Nationwide, Cardinal Health, Abercrombie. It is the 2nd > largest business incubator. People generally have decent insurance. I am in > Central Ohio and have a bustling practice. I am in an area where no one even asks > if I take Medicaid. The only Medicaid I pts I have are those who have it > secondary to medicare. I do see a fair number of self pay patients who get a 50% > discount on my fees (for paying at the time of service to get around > insurance contract issues) > > Brock is in a rural area, albeit one that has some patients with good > jobs and insurance. The problem is he is in a hospital supported practice that > brought him in to take care of their population... Uninsured and medicaid > patients. His experience is definitely not the norm here, although there is > a little strip of family practices on the west side of town ( being > outside of town on the west side) and another on the east side, that focus on > medicaid patients. These practices see 60 pts a day per doctor in a remarkably > assembly line like way. They also make a bundle and have patients trained to > like their 2 minute visit. There is no way I could do that, I would lose my > mind and my patients wouldn't tolerate it. > > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover. <http://discover.aol.com/memed/aolcom30tour> aol.com/memed/aolcom30tour > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2007 Report Share Posted September 2, 2007 Thought you said 80% of specialists in Maine work FOR hospitals, not themselves... Matt Levin MD in Western Pa Solo since Dec 2004 Re: dead zone reportThe dead zone thing is very strange to me as some folks inthe same general area can have such different experiences.Must be many more factors at play than meet they eye.Pt panel, doctor personality/skill, supportive (or not)community could be a few. A guess the right mix couldmake a successful practice even in a lower reimbursement,higher malpractice "dead zone"....Thanks for the correction! I thought reimbursement in central Ohio was 1/3 of Eugene, Oregon levels. Maybe these are justrural medicaid numbers? hmmm....Pamela>> Pamela, please don't include Central Ohio in your list of dead zones. > Columbus is the 16th largest city in the US and is the headquartersfor The > Limited Brands, DSW, Nationwide, Cardinal Health, Abercrombie. It isthe 2nd > largest business incubator. People generally have decent insurance. Iam in > Central Ohio and have a bustling practice. I am in an area where noone even asks > if I take Medicaid. The only Medicaid I pts I have are those who haveit > secondary to medicare. I do see a fair number of self pay patients whoget a 50% > discount on my fees (for paying at the time of service to get around > insurance contract issues)> > Brock is in a rural area, albeit one that has some patients withgood > jobs and insurance. The problem is he is in a hospital supportedpractice that > brought him in to take care of their population... Uninsured andmedicaid > patients. His experience is definitely not the norm here, althoughthere is > a little strip of family practices on the west side of town (being > outside of town on the west side) and another on the east side, thatfocus on > medicaid patients. These practices see 60 pts a day per doctor in aremarkably > assembly line like way. They also make a bundle and have patientstrained to > like their 2 minute visit. There is no way I could do that, I wouldlose my > mind and my patients wouldn't tolerate it. > > > > ************************************** Get a sneak peek of the all-newAOL at > http://discover. <http://discover.aol.com/memed/aolcom30tour>aol.com/memed/aolcom30tour> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2007 Report Share Posted September 7, 2007 All Medicaid in western PA is assigned to 1 of 3 HMOs. If pt does not got the "chosen doc" the pt has to pay, but the "out of network" doc cannot order tests, supplies etc. All for $31.90 per visit. So, could see an MA pt, but they'd have to have all testing ordered by someone else, and if pt didn't follow through, your neck is on the line.... not worth it. M Re: dead zone report Are you allowed to charge medicaid pts a private contract fee withoutopting out "officially"? Why is this different than medicare?Pamela>> It is not only about reimbursement, it is about the surreal amount of rules and regulations > that we have to follow.> I send sometimes patients to the University of Chicago for a second opinion. Lately, I have to > fax something at least twice before they find it, I started noticing that consult letters take > longer and longer to come back and often get misplaced. There is less communication and > more frustration, even among the specialists who used to be "shielded" from the hassle. This > is not (only) about money, it is about unhappy/unskilled people becoming superficial.> I do not take medicaid either. I charge medicaid patients a very reasonable fee and they don't > have to wait, they get as much time as they need. The fee has to cover my malpractice > insurance (17.000 a year for part time policy), rent and phone bill. My work, time and skills > are free, rent and malpractice are not and if they don't like it, they can go to the free clinic or > to the doctor across the street who gives them 5 minutes from his time after one hour wait > and never calls back when they need him.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2007 Report Share Posted September 7, 2007 I dunno why it is differnt but NO you either take a medicaid aptietn and accept the fee or you cannot seethem It is illegal for the patietn on mediciad to pay you cash Though I had one drug abuse one who denied she had anyinsurance and then umm did not pay her bills... People offer to see me all the time andpay me becasue they want to see me. CAnnot do itThem's the Rules. Re: dead zone report Are you allowed to charge medicaid pts a private contract fee without opting out " officially " ? Why is this different than medicare? Pamela > > It is not only about reimbursement, it is about the surreal amount of rules and regulations > that we have to follow. > I send sometimes patients to the University of Chicago for a second opinion. Lately, I have to > fax something at least twice before they find it, I started noticing that consult letters take > longer and longer to come back and often get misplaced. There is less communication and > more frustration, even among the specialists who used to be " shielded " from the hassle. This > is not (only) about money, it is about unhappy/unskilled people becoming superficial. > I do not take medicaid either. I charge medicaid patients a very reasonable fee and they don't > have to wait, they get as much time as they need. The fee has to cover my malpractice > insurance (17.000 a year for part time policy), rent and phone bill. My work, time and skills > are free, rent and malpractice are not and if they don't like it, they can go to the free clinic or > to the doctor across the street who gives them 5 minutes from his time after one hour wait > and never calls back when they need him. > Quote Link to comment Share on other sites More sharing options...
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