Medicaid shows that access to a government health care program does not guarantee access to health care

WASHINGTON — Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.

The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor

http://www.nytimes.com/2014/09/28/us/for-many-new-medicaid-enrollees-care-is-hard-to-find-report-says.html

Here is a post I made on PDF about physicians reluctance to accept Medicaid.



http://healthpolicy.wustl.edu/Content/HealthCareAccess.html?


OpenDocument Overview
Washington University
Organization
Director and Staff
Events
Events






Health Care Access for Medicaid Patients – Physicians and Dentists Interview Study

i. executive summary




When physicians and dentists were asked what the greatest business challenges in accepting and treating Medicaid patients are, they responded:
§ Low/slow reimbursements
§ Excessive paperwork/authorization problems
§ Abuse of system/lawsuits

When physicians and dentists were asked what the greatest medical challenges in accepting and treating Medicaid patients are, they responded:
§ Sicker/needier patients
§ Non-compliant/undependable patients
§ Difficulty in making referrals
§ Treatment not covered
§ Patients’ bad attitudes

According to physicians/dentists interviewed, treating Medicaid patients takes more time and resources. They are sicker/needier than other patients and tend not to comply with instructions/prescriptions due to lack of education and other personal/health issues.

Although Medicaid patients are generally a more difficult, time-consuming and expensive population to work with, according to responding physician/dentists, most doctors indicated they would be willing to take/take more Medicaid patients if reimbursements were on the same par as Medicare or other insurance programs.

Dentists were less likely to accept Medicaid patients than physicians, and spoke of low reimbursements and treatments not covered as reasons why. One dentist noted the difficulty, or impossibility, in finding specialist dentists to perform procedures such as wisdom teeth removal or root canals for Medicaid patients.
Executive Summary

Beyond the solution of increasing reimbursements, physicians/dentists offered several suggestions to “fix” Medicaid:
§ Institute a patient co-pay
§ Provide protection from lawsuits
§ Speed up the payment of reimbursements
§ Penalize no-shows
§ Allow necessary treatments
§ Allow paper claims
§ Change punitive system
§ Institute better screening.


Physicians and dentists from the five Missouri regions who were interviewed for this study gave consistent responses, and no notable differences were found.






Low/Slow Reimbursement
“I can’t stay in business with what they currently pay.” (St. Louis County/family general practice/Takes Medicaid)
“I can’t afford to keep it up. I’m losing money financially.” (Bootheel/ dentist/Takes Medicaid)

“Sometimes they will overwhelm your practice and I can’t make a living accepting many. They don’t show up for appointments or value your services.” (Springfield/dentist/Takes Medicaid)

“The reimbursement is low and the whole program is a big hassle.” (St. Louis County/psychiatrist/Does Not Take Medicaid)

“It’s financial. My office manager has said keep it less than ten percent or I’ll go bankrupt.” (Cape Girardeau/pediatrician/Takes Few Medicaid)

Non-Compliant/Undependable Patients
“Because they are no-shows.” (St. Louis City/neurologist/Takes Few Medicaid)
“The aggravation factor. Compliance is an issue. These patients won’t change their lifestyle. The don’t show up for appointments and some have poor hygiene. You have to air the room when they leave.” (Springfield/family general practice/Takes Few Medicaid)

Sicker/Needier Patients
“It’s harder to deal with Medicaid patients. I am compensated less, and I had to call the police once with a troubled patient.” (Cape Girardeau/allergist/Takes Medicaid)
“Usually they are the most needy, and we work harder because of major medical problems, like a disabled child. Their expectations are too unreal medically, and they object if I prescribe a medication allowed by Medicaid and not one of their choice. They make appointments more often than necessary, and many like to hang around and talk to my staff about their problems.” (Cape Girardeau/pediatrician/Takes Few Medicaid)

Good Morning Joanie,
Yes, physicians hate to take it because as we know it doesnt pay enough to cover the cost. Many practices will take a certain number of medicaid patients as a form of charity, but not many.

heres another article. there are so many as you know.

About 46 percent of physicians accept Medicaid, according to a 15-city survey last year by staffing firm Merritt Hawkins. That’s down about 10 percent from four years before. To encourage primary-care doctors to take Medicaid patients, the Affordable Care Act has temporarily increased the program’s payments to doctors, matching Medicare’s higher rates through 2014. But the boost doesn’t apply to specialists such as cardiologists and oncologists. “What they pay doesn’t even come close to covering expenses,” says Pat Howery, the administrator at Colorado West Otolaryngologists, an ear, nose, and throat clinic in Grand Junction. For a basic office visit, Howery says, UnitedHealth Group (UNH) pays $119 and Medicare $73; Medicaid comes in at $52. “You can’t make this up in volume,” he says. In January the clinic began limiting each doctor to two Medicaid appointments a day
http://www.businessweek.com/articles/2014-04-10/doctors-shun-patients-who-pay-with-medicaid

that article also states that there are 10% fewer doctors accepting medicaid than 4 years ago. thats bad, because the number was already low. and even fewer if you need a specialist.

The whole country is going to go broke when this scam is due. and people will not be getting better care. I stand by that they are ruining the entire system for a few. but mostly its a power grab.

I wish I thought it really mattered to everyone.  The only answer is single payer insurance like other countries have, along with price controls on the entire healthcare industry.

I don't see any doctors or health care moguls living in shacks in the US. My heart just can't bleed for them.

Eddard wrote:

I wish I thought it really mattered to everyone.  The only answer is single payer insurance like other countries have, along with price controls on the entire healthcare industry.

I don't see any doctors or health care moguls living in shacks in the US. My heart just can't bleed for them.

Oh please, give me a break.  

Would you want to live in a shack after 12 years of school, 4 years of college, 4 years of medical school, 3-7 years in a residency,  and then possibly several more years of fellowships for a specialty in your field. Then start adding up the cost, the dedication to studies, the long hard grueling hours and of course the stress.

That's lame and I hate it when someone falls back on that kind of logic.

Not to mention the student loans and malpractice insurance.  They start out with a huge monkey on their back.

I wish hospitals were realistic in their charges.  I have been reading horror stories lately about them charging obscene rates for meds, procedures, beds, well... everything.  We all know this happens.  It is no wonder that medical tourism (where patients go to foreign countries for treatment) is so popular.

Want to see some horror stories? Read this http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

My niece prior to graduating med school spent over $7,000 in application fees, fees to apply to residency programs. When her applications were accepted she had to finance her flights and hotels for her interviews. Nothing cheap about becoming a doctor.

Joanimaroni wrote:

Eddard wrote:

I wish I thought it really mattered to everyone.  The only answer is single payer insurance like other countries have, along with price controls on the entire healthcare industry.

I don't see any doctors or health care moguls living in shacks in the US. My heart just can't bleed for them.

Oh please, give me a break.  

Would you want to live in a shack after 12 years of school, 4 years of college, 4 years of medical school, 3-7 years in a residency,  and then possibly several more years of fellowships for a specialty in your field. Then start adding up the cost, the dedication to studies, the long hard grueling hours and of course the stress.

That's lame and I hate it when someone falls back on that kind of logic.

Unfortunately those in the medical profession have been painted as bad guys from simply expecting to be paid for their services provided... May be part of the reason many have decided to retire...

I worked for a surgeon for 15 years.....I also took call with him. My paycheck reflected the long hours we spent, working around the clock.

USA debt free after corporate sponsorships. President McDonald promises $1 Healthcare with the purchase of a large Coca-Cola

Doctors in other countries don't live in shacks. They still live better than people in other occupations but they aren't as super-rich as the ones here in America are. They don't spend as much and get as in debt in other countries to become doctors either.
Would you rather be treated by a government paid doctor who might be in it because he cares about you or one who just wants your money?

Doctors Without Borders live in tents. I guess they are stupid. Right?

Eddard, most people in America live in better houses than elsewhere.

Only a few doctors, when compared to their associates, are "super rich". I don't hate them for earning a decent living after busting their butts in school and residency for a third of their lives. My degree is in Biology and I studied beside Pre-med students who had to get straight "A's" in every subject in order to get into med school. Their social lives were nonexistent and they seemed about to go off the deep end before any exam.

They have earned their rewards.

Now, HOSPITALS are a different thing. Overcharging is their despicable modus operandi.

Are you attemting to say government doctors are better because they care or because they are more intelligent and better trained?

There are doctors that are nice, caring and considerate.....and some of those are terrible practitioners that I wouldn't let come near me. I also know physicians that are total assholes void of bedside manners that I would seek out in a heartbeat if I needed the very best in their specialty.

You are not making your point.

Well a modern CT tube can cost over $200,000 and a detector package over a million...plus 400 dollars an hour to install and calibrate them....The service contracts are astronomical. So to function the hospitals have to have the CTs MRIs PET scanners, various xray units and a bunch of people to operate them sometimes 24/7 ...Modern technology isn't cheap. We could go back to where does it hurt and take two aspirin but people have gotten use to MUCH MUCH MORE.

TEOTWAWKI wrote:

Well a modern CT tube can cost over $200,000 and a detector package over a million...plus 400 dollars an hour to install and calibrate them....The service contracts are astronomical. So to function the hospitals have to have the CTs MRIs PET scanners, various xray units and a bunch of people to operate them sometimes 24/7  ...Modern technology isn't cheap. We could go back to where does it hurt and take two aspirin but people have gotten use to MUCH MUCH MORE.

You got that right.

What I would like is for all the limousine liberals to setup hospitals for poor people who cant afford insurance. Liberals are the richest people on the planet.

People, outside of the medical field, have no idea how difficult and expensive it really is.

Joanimaroni wrote:

People, outside of the medical field, have no idea how difficult and expensive it really is.

No they really don't.

and what irks me is that these same people who used to hate insurance companies are in bed with them while the premiums go up and the covered services go down.

They scream about the high cost of healthcare, but never think of all the products, medicines, equipment, training, education, regulations etc et et c goes into just seeing someone in the door to out the door. Its a phenomenal extensive process that requires so many trained people in so many departments.

And they bitch about what a 3-5% profit? which is about the average profit for a hospital.

That is used for capital purchases, and yes salary increases. Hell, from what I understand the lady over the college there makes more than the CEO of the hospital. And if you put all hospital CEO's salary in a bucket it wouldn't fund one hospital for a year. NOT ONE

So its the salaries of the working staff these people are angry at.

Since somebody told me I'm not making my point I'll go back to the title of this thread. To rephrase it: no access to medicaid and no money for insurance guarantees no access to health care. That's a point that no one can argue with.

The real question is if it matters to Americans that their fellow citizens can go see a doctor when they are sick.
Foreigners are willing to pay higher taxes so that can happen.
Americans today believe in dog eat dog. They didn't used to but they do now.

By the way, with all due respect, I don't think you have a clue what CEO's of major hospitals earn. Nobody I know complains about nurses salaries. The high ranking paper pushers at hospitals get big money, FYI.

http://www.beckershospitalreview.com/compensation-issues/ceo-compensation-of-the-25-top-grossing-non-profit-hospitals.html

I said you were not making your point when you posted this.......


PostSubject: Re: Medicaid shows that access to a government health care program does not guarantee access to health care Wed Oct 01, 2014 10:32 pm Reply with quote
Doctors in other countries don't live in shacks. They still live better than people in other occupations but they aren't as super-rich as the ones here in America are. They don't spend as much and get as in debt in other countries to become doctors either.
Would you rather be treated by a government paid doctor who might be in it because he cares about you or one who just wants your money?

Doctors Without Borders live in tents. I guess they are stupid. Right?

The problems with medicaid reimbursements was posted on page one. It is s huge problem and has nothing to do with doctors not living in shacks. You can not run a buisness that has a high overhead and not get paid enough to cover your practice expenses.

Eddard. It wasn't till about 50 years ago that Americans got any form of freebie healthcare so what do you mean Americans didn't used to be that way? Americans used to understand they had to provide services for themselves and they also understood some people had more than them and that was how it is not try and take from others .

We have several child health plans and we have elderly plans

And people in foriegn countries don't have a choice but to pay high taxes, they have a socialist gov that is broke

The problem in this country is we have too many people who think oh the gov will pay for it and not enough of the I take pride in taking care of myself people

Exactly. In the 1930's when FDR was in office in Washington and people like Huey P Long were in power in the South, all Americans favored the government doing whatever it could to help out their fellow citizens. This country was not split into two warring camps back then.
When I said Americans didn't used to be that way, I was referring to the pre Ronald Reagan years before selfishness became such a popular idea. I remember a time when Americans didn't wear the labels on their shirts on the outside to impress people with how much money they spent on them and when converse tennis shoes were the only name brand out there.
We were better people back then. You may disagree but I don't much care.
There are some things that I'm sure of and that's one of them.

Eddard wrote:

Exactly. In the 1930's when FDR was in office in Washington and people like Huey P Long were in power in the South, all Americans favored the government doing whatever it could to help out their fellow citizens. This country was not split into two warring camps back then.
When I said Americans didn't used to be that way, I was referring to the pre Ronald Reagan years before selfishness became such a popular idea. I remember a time when Americans didn't wear the labels on their shirts on the outside to impress people with how much money they spent on them and when converse tennis shoes were the only name brand out there.
We were better people back then. You may disagree but I don't much care.
There are some things that I'm sure of and that's one of them.

Oh I see, you meant the era before the GOV created all the selfish entitled people who would prefer to spend their money on movie tickets, nice cars, jewelry, $200 shoes, fancy cloths while having a obamaphone, subsidized housing, foodstamps and free health insurance to pay for their pain pills.

Yes, I vaguely remember those days.

Remember savings accounts? Why isn't that a popular idea?

The Dude wrote:

Remember savings accounts? Why isn't that a popular idea?

I don't know really. Its seems to me just from my point of view of growing up in the last 50 years that people just don't have pride in self reliance anymore. They are more embarrassed to wear old shoes than they are to stand in a welfare line.

This is just my opinion of course from knowing people like that, friends and yes some family.

Sometimes I feel like I'm stupid because I feel so strongly against that type of behavior and honestly it makes me mad when I see people who are not working driving better cars than me and eating better than me who are getting GOV assistance. And people can call it what they want. Its just wrong.