Medicaid pays doctors less than minimum wage for an hour's work...

[drusso]

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[deleted480308]

just don't take medicaid...problem solved

 

[bedrock]

http://getbetterhealth.com/why-would-any-doctor-accept-medicaid/2015.01.26?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed: getbetterhealth/blog (Getting Better - Blog)&utm_content=FaceBook

Wow nice post. That's even worse than I thought. I'm so never taking Medicaid. It's just a joke. Call it what it is----charity care. At least that way, the physicians who see these patients could be appropriately recognized for their charity work.

 

[PinchandBurn]

this is seriously ridiculous. I hope this gets noticed around the country...

 

[Ligament]

Wow nice post. That's even worse than I thought. I'm so never taking Medicaid. It's just a joke. Call it what it is----charity care. At least that way, the physicians who see these patients could be appropriately recognized for their charity work.

Except that its not charity care. It is money stolen from the taxpayers to in turn send "patients" to STEAL from physicians. Just passing the theft along.

True charity has merit! Medicaid is theft and waste.

 

[clubdeac]

So does anyone know what Medicaid pays for office visits and ESIs, mbb's, SIJs etc? I was told that where I'm at we get paid more for an SIJ injection in a medicaid patient than medicare

 

[Ligament]

Im all for physicians making sufficient profit such that they can give true charity care.

 

[Louisville04]

Except that its not charity care. It is money stolen from the taxpayers to in turn send "patients" to STEAL from physicians. Just passing the theft along.

True charity has merit! Medicaid is theft and waste.

This should be prosecuted to the full extent of the law

 

[Ducttape]

In reality, treating Medicaid patients is charity work. The fact that any physicians accept Medicaid is a testament to their generosity of spirit and missionary mindset.

up to 40% of my practice is medicaid.

i would say roughly 25% of them do work. many of them are appreciative of the care they get.

 

[NOSfan]

Less than minimum wage doesn't bother me.....I just work harder for TIPS

 

[lonelobo]

those posted charges don't mean a lot taken out of context,
Less than Minimum wage really? I don't think so.
Level 3 NP visit done in 20 min pays around $90 for me, so if I did 3 that is $270 /hr.... not sure where they pay that kind of minimum wage.

Do I want a whole practice of medicaid? no but I would say about half have jobs and are actually much more pleasant to treat than some of my "entitled " commercial pts

 

[Ducttape]

the bill shows how much is being covered by medicaid.

what is column 1?

just says un- its. im not sure what was billed. was it for 9921X? if so, that person is charging a lot for follow up appointments. bottles of depomedrol? vials of flu vaccine? units of botox?

 

[kstarm]

the bill shows how much is being covered by medicaid.

what is column 1?

just says un- its. im not sure what was billed. was it for 9921X? if so, that person is charging a lot for follow up appointments. bottles of depomedrol? vials of flu vaccine? units of botox?

From the comments:

"I’m the friend who posted the Medicaid of NY EOB on a social network.....I’m an ophthalmologist who opened my own practice in August 2014. Each one of the units on the EOB represents either a comprehensive ophthalmic exam (92004 or 92014), a follow-up visit (92002 or 92012), or a specialized service such as a visual field examination. Each one of these services takes 30-60 minutes of my time and the time of my staff. As you may know, ophthalmic exams require dilation in most cases, which means the patient comes into the exam room at least twice, and may have other testing (for diabetic retinopathy, glaucoma, or corneal ectasias while they wait). I spend a considerable amount of time with my patients, and my diagnostic equipment does not come cheap. My overhead is $18,000 a month (or a little over $100/hour for an average of 22 workdays a month). The payments on the EOB represent services that take 30-60 minutes of my time, which works out to between $4.35 to $8.70/hr. In order to comply with HIPPA regulations, I did not supply the entire EOB (next column over to the right contained patient names), but trust me, this IS real."

 

[Ducttape]

no offense...

but i take Medicaid of NY. i dont have reimbursements that low.

i agree, a lot gets denied.

and - drusso will especially hate this - the only way this office is able to stay financially viable and see so many Medicaid patients is because of site of service differential. if your dreams of equality in site of service comes to fruition, then i will be forced to stop seeing Medicaid, as it is not financially viable. (fyi i do not bill site of service for follow up and evals - only procedures)

will i be upset? probably not, but my ability to serve the greater good (by seeing so many of these patients and not prescribing/recommending hydro-oxycodone) will be significantly reduced.

but then again, i can serve my public good by focusing on $$$ alone...

 

[drusso]

no offense...

but i take Medicaid of NY. i dont have reimbursements that low.

i agree, a lot gets denied.

and - drusso will especially hate this - the only way this office is able to stay financially viable and see so many Medicaid patients is because of site of service differential. if your dreams of equality in site of service comes to fruition, then i will be forced to stop seeing Medicaid, as it is not financially viable. (fyi i do not bill site of service for follow up and evals - only procedures)

will i be upset? probably not, but my ability to serve the greater good (by seeing so many of these patients and not prescribing/recommending hydro-oxycodone) will be significantly reduced.

but then again, i can serve my public good by focusing on $$$ alone...

Yep. I hate it: Bad public policy. Bad for government. Bad for patients. It's dressed-up socialistic economic redistribution.

 

[powermd]

Medicaid in my state pays 83% of the Medicare facility fee rate for hospital based procedures. That's better than commercial insurers for IPM services. Interestingly the DON'T pay for procedures done in an ASC.

 

[buddy 2004]

Wow nice post. That's even worse than I thought. I'm so never taking Medicaid. It's just a joke. Call it what it is----charity care. At least that way, the physicians who see these patients could be appropriately recognized for their charity work.

Is there a way to take charity cases officially and get a tax write off? Or do you have to be a non-profit? At least with true charity work there may be some protection from litigation via Good Samaritan rules. I would rather do that than open the door to Medicaid.

 

[emd123]

Is there a way to take charity cases officially and get a tax write off? Or do you have to be a non-profit? At least with true charity work there may be some protection from litigation via Good Samaritan rules. I would rather do that than open the door to Medicaid.

No you cannot write off charity cases as a doctor. I did THOUSANDS while in the ER. Made illegal by federal government for you to deduct that as a loss or charity "donation."

 

[deleted480308]

Is there a way to take charity cases officially and get a tax write off? Or do you have to be a non-profit? At least with true charity work there may be some protection from litigation via Good Samaritan rules. I would rather do that than open the door to Medicaid.

In florida they grant mallpractice/liabilty immunity to docs that are providing services through a charitable entity like a free clinic and for docs treating patients referred to them through those free clinics. You can contact/google shepherd's hope in orlando if you have any specific questions about how that works

 

[clubdeac]

those posted charges don't mean a lot taken out of context,
Less than Minimum wage really? I don't think so.
Level 3 NP visit done in 20 min pays around $90 for me, so if I did 3 that is $270 /hr.... not sure where they pay that kind of minimum wage.

Do I want a whole practice of medicaid? no but I would say about half have jobs and are actually much more pleasant to treat than some of my "entitled " commercial pts

You get $90 for a level 3 NP visit?? I as a physician only get $75. How is that

 

[Ducttape]

No you cannot write off charity cases as a doctor. I did THOUSANDS while in the ER. Made illegal by federal government for you to deduct that as a loss or charity "donation."

when you are working in ER, you are not doing charity cases, unless you are self-billing, which is very uncommon in ER.

the hospital is.

 

[lonelobo]

You get $90 for a level 3 NP visit?? I as a physician only get $75. How is that

NP New Patient

 

[emd123]

when you are working in ER, you are not doing charity cases, unless you are self-billing, which is very uncommon in ER.

the hospital is.

Every ER group I ever worked with was private, not Hosp employed and we were responsible for billing along with collections and losses. Fully private groups.

Most EPs are not hospital employed. Most are either in private democratic groups or in staffing megagroups (EM care, Team health etc) neither of which are hospital employed. So ultimately no pay patients affect collections, which affects collections available to pay the doctors. I personally, lost hundreds of thousand of dollars, over a ten year period on self-pay/no-pays that were not tax deductible losses.

When's the last time your worked EM?

 

[Ducttape]

2006.

i did work in 2 private groups, in 1992-1998. one went out of business. the other contracted with local hospitals, but for both, physicians were paid on an hourly basis, not fee for service.

other than that, having worked 4 other ERs, all the time hospital employed.

i have clocked in over 33,000 hours in ER. maybe im just lucky or chose the right jobs, but i never personally lost any money due to self/no pays.

 

[emd123]

2006.

i did work in 2 private groups, in 1992-1998. one went out of business. the other contracted with local hospitals, but for both, physicians were paid on an hourly basis, not fee for service.

other than that, having worked 4 other ERs, all the time hospital employed.

i have clocked in over 33,000 hours in ER. maybe im just lucky or chose the right jobs, but i never personally lost any money due to self/no pays.

At the jobs where you were paid hourly, the pot of money available to pay the physicians and set the hourly rate must have been based on collections. If a large percentage of collections were $0, ultimately they had less money available to pay you and likely kept a lower hourly salary than if collections were higher. Self-pay and no-pays drive down ED physician hourly, without a doubt. You might not have seen it on your paycheck or W2, but when you pour over the nuts and bolts of the accounting, that's how it works out. I suppose it's an annoying discussion on accounting at this point, but that's how I've seen it work from the inside. I'm on the board of a multispecialty group now, who has a small EM contract and we have to go over this stuff in detail to decide how much these guys can get paid. They see it as an "hourly rate" but if the money ain't comin' in, that rate's going to drop at some point. Either way, I've never seen an example of patients not paying their bills, resulting in an increase in doctor pay.