Medicaid Modus Operandi – Limit Access, Save Money

barrel-wForget the fact that Medicaid payments to physicians amount to less than the cost of a lunch at McDonalds in some states.

According to an article published in the Dec 8 edition of AM News, bureaucratic hassles and delays in payments are also causing significant limitations to the number of physicians that are willing to provide care for Medicaid patients.

What good is health insurance if you’re prevented from using the benefits?

Pennsylvania and New York take an average of almost 4 months to pay a Medicaid claim. Some claims take even longer to be paid in those states. To put this in perspective, imagine starting work at a new job, then waiting an average of 4 months to get your paycheck (if you’re lucky you’ll get paid in 2-3 months, but if you’re unlucky, you might wait 6 months). Is that somewhere you could afford to work? How would you pay for your mortgage, your car payment, or your groceries? By delaying payments for services, states are forcing some physicians to close up shop.

Not only do Pennsylvania and New York withhold payments, those states also happen to be two of the states that pay the least for Medicaid services in the US. New York pays $20 for a one hour consultation on a new patient. Hell, my babysitter makes almost that much – and she doesn’t have to purchase a $1 million malpractice insurance policy. Now New York is going to cut Medicaid payments further? (h/t to Kevin for the link)

By encouraging hassles and purposefully delaying payments, states are limiting access to medical care.

If you can’t get in to see a doctor, then the states don’t have to pay the doctor.

Great way for states to minimize budget shortfalls – receive a portion of the 15.4% taken from every working person’s paycheck, pay a pittance for the services … and delay payment for the services, piss off enough medical providers so that very few people provide the services, and then keep most of the money.

If I had a business that accepted money for services and then provided half-assed results, I’d be sued and probably charged with a crime. The state Attorney General may even come after me.

Sure don’t see the Attorney General stepping in and going after states to make them pay the money they owe to medical providers.

Strange how things work sometimes.

Picture credit here
Full AM News article below for those who don’t have access to the AM News site

Medicaid pay delays found to squeeze access

Bureaucratic hassles can discourage physicians from seeing new Medicaid patients.

By Doug Trapp, AMNews staff. Dec. 8, 2008.

Washington — Physician participation rates in Medicaid aren’t just about the money, they’re also about the time.

A recent analysis concluded that while pay is the primary factor in whether doctors see Medicaid patients, slow paychecks from states can negate some of the positive effects of higher fees. The analysis examined Medicaid participation, pay rates and payment speed for nearly 5,000 physicians in 21 states. Health Affairs published the study online Nov. 18.

Although the speed of Medicaid pay has no independent effect on participation, it can dampen the participation boost that otherwise would come by combining high pay and quick turnaround, the study concluded. Sixty-four percent of physicians in states with above-average pay were estimated to have accepted all new Medicaid patients in 2004-2005. But that percentage declined to 51% for doctors who received better-than-average pay at a below-average pace.

“This study strongly suggests that higher Medicaid fees won’t have the desired effect of increasing patient access if physicians have to wait months to get paid,” said Peter J. Cunningham, PhD, study co-author and senior fellow at the Center for Studying Health System Change, a health care research organization.

This conclusion is important because Medicaid is under enormous pressure from the slowing economy, said AMA Board of Trustees Chair Joseph M. Heyman, MD. “Eliminating administrative hurdles and ensuring adequate and timely Medicaid payments to physicians is vital to improve the viability of the program.”

The pace of pay was based on 2006 statistics from Athenahealth, a billing services provider, and fee rates were based on a 2003 state survey, the most recent available. Participation levels came from the 2004-2005 Community Tracking Study Physician Survey.

The analysis was limited by the available information, the study acknowledged. However, the authors are confident that closing data gaps would not have affected the conclusion, said co-author Ann S. O’Malley, MD, MPH, senior health researcher for the Center for Studying Health System Change.

The study found a wide variation in pay timeliness for the 21 states in the survey. The slowest state in 2006 was Pennsylvania, which averaged 114.6 days per claim. Kansas was the fastest at 36.9 days per claim.

Medicaid pay in Pennsylvania has quickened in the past few years, according to Bernard Lynch, senior director of payer relations for the Pennsylvania Medical Society. Lingering implementation problems with a new online billing system in 2003-2004 may have contributed to the state’s poor showing in the survey, he said.

Pennsylvania also has started paying more for evaluation and management services in the last two years, Lynch said. “There has been recognition that physician fees are relatively low compared to commercial payers.”

The second slowest state was New York, at 111.5 days per claim. Doctors there are required to file a request to submit a claim, said Andrew Merritt, MD, a family physician and chair of the Medical Society of the State of New York’s Health Care Services and Medicaid Committee. The state uses these controls mainly to prevent fraud and abuse, but it puts increased administrative work on all physicians, he said. “The hassle factor in dealing with them is way too high.”

South Carolina is the second-fastest paying state for Medicaid, with an average of 37.3 days per claim, the study found. Gregory Tarasidis, MD, board chair of the South Carolina Medical Assn., agreed that doctors are paid in “a pretty timely fashion.”

But the state’s pay rate still causes issues, Dr. Tarasidis said. South Carolina recently rolled back a physician pay increase and may implement an additional pay cut to address its budget problems, which could lead some doctors to restrict the number of Medicaid patients they see, he said.

7 Responses to “Medicaid Modus Operandi – Limit Access, Save Money”

  1. kmomjl says:

    i watched a demented old woman die a painful death due to badly abcessed teeth. Due to her age and mentation she required sedation to extract the teeth which could not be done in the nursing home setting. Medicaid determined not medically necessary so she was in constant pain, stopped eating became malnourished and dehydrated and died. I can’t say anymore other than I’ll never forget her. I’m from missouri by the way

  2. igloodoc says:

    So the death spiral starts.

    -Medicare slow to reimburse or not reimbursing
    -Next, off-load the patients to the ER where federal laws require all people to be seen regardless of payment, or quantity of payment.
    -Further cut reimbursement due to the increased utilization of expensive emergency care.
    -Doctors leave medicare/medicaid in droves. ERs are crushed with patients.
    -Hospitals finally get it and also drop out.
    -No one can get medicare/medicaid care from providers or hospitals, so media goes crayzee with stories like the one above.
    -Doctors portrayed as cruel, heartless capital industrialist pig dogs running the imperialistic medical system by the media.
    -National Health Care implemented to put the medical system in its place.
    -Then the fun begins…

  3. Dan says:

    Facts that are believed to exist regarding the present U.S. Health Care System-
    This may be why about 80 percent of U.S. citizens want our health care system overhauled:
    The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
    U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care cost presently is over 2 trillion dollars of our gross domestic product. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
    We have around 50 million citizens without any health insurance, which causes about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children that covers about 7 million kids.
    Our children
    Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits.
    About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA.
    Our health care we offer citizens is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
    Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported. It is estimated that we need about 60 thousand more primary care physicians to satisfy the medical needs of the public health in the United States. And we have some greedy corporations that take advantage of our health care system. Over a billion dollars was recovered for medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy.
    Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up the U.S. Health Care System, which is why the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:
    Access- citizens do not have the right or ability to make use of this system as we should.
    Efficiency- this system strives on creating much waste and expense as it possibly can.
    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
    Sustainability- We as citizens cannot continue to keep our health care system in existence , or tolerate it as it exists today any longer,
    Dan Abshear

  4. kmomjl says:

    igloodoc not sure whether your comment was a slam on my antecdote….my experience with medicaid is not only do they not reimburse providers but also deny recepients. lots of abusers in medicaid but this poor old lady wasn’t one of them.

  5. Pink says:

    “United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:
    Access- citizens do not have the right or ability to make use of this system as we should.
    Efficiency- this system strives on creating much waste and expense as it possibly can.
    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
    Sustainability- We as citizens cannot continue to keep our health care system in existence , or tolerate it as it exists today any longer.”

    Dan, sweetie, you forgot the primary part of this equation…the doctors.

    Where is this magical pool of doctors going to come from? Because if you are basing it on the reimbursement they are getting now….well, good luck with that.

  6. igloodoc says:

    Sorry, no slam intended. There will be more stories like the one you related. Sadly, as we see with Dan’s comments, the real culprits (ie Government) create the mess will not be villified. Instead it will be physicians.

    Just look at how EMTALA got its start. The evil hospitals and doctors were doing wallet biopsies and sending poor people to the county hospitals with “stable” transected aortas. The angelic congress had to step in, to save the children or some such.

    Now, it is so much better. Every patient gets everything. Pay for it…no need… EMTALA says you get it. Studies show EMTALA has only added a half hour on to the time to transfer that transected aorta because the hospital you work at no longer has a vascular surgeon. Why? The hospital’s vascular surgeon refuses to take call because of too much liability for little or no reimbursement. So the ER Doc spends time calling hospitals and filling out mandated EMTALA forms and voila… one half hour.

    Ironic, isn’t it?

  7. kmomjl says:

    igloodoc.old as the hills here. started out at the “city” hospital in st. louis pre-emtla..those were sad days. it is ironic that what was designed to protect became as you describe. fast forward to hippa and “never events” and it’s just more of the same. I could go postal at work if I get more one more piece of paper to fill out in this chess game with government regs. Thanx for the reply

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