what to do when Medicaid/self-pay pts need outpt specialists?

[MeowMix]

We cannot find ANY orthopaedist, rheumatologist, neurologist, or endocrinologist to see Medicaid pts from our clinic in a major metro area. Gyn onc and many other specialties are nearly as impossible. They all want exorbitant up-front cash payments from self-pay pts ($720 to see the pulmonologist as an outpt).

I know the specialists are busy. Why should they work for inadequate reimbursement that doesn't pay their bills?

But how are we supposed to care for these often very complex patients? Suggestions would be useful.

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[deleted87716]

Basically, what you need are people who are willing to provide charity care. Do you have any free clinics in your area that specialists are involved in? Are there any local charitable organizations designed to improve access for self-pay patients (we have one called "Project Care" in my area)?

You may also have to look outside the immediate vicinity to find people who are willing to see these patients. It may involve additional travel on the patients' part, but that's better than nothing.

Another more time-consuming option is to contact the specialists individually (not the office managers) and talk to them about the problem face-to-face. You might be able to work something out with some of them.

Finally, bring the issue forward to your state's Medicaid commission, state legislators, and your state AAFP chapter. This won't result in any quick fixes, either, but nothing will happen with Medicaid until the government wants it to.

Medicaid and self-pay are separate issues. Supposedly, the healthcare bill will improve the self-pay situation by reducing the number of uninsured...we'll see how that works out.

 

[JackADeli]

We cannot find ANY orthopaedist, rheumatologist, neurologist, or endocrinologist to see Medicaid pts from our clinic in a major metro area. Gyn onc and many other specialties are nearly as impossible....

But how are we supposed to care for these often very complex patients? Suggestions would be useful.

Basically, what you need are people who are willing to provide charity care...

You may also have to look outside the immediate vicinity...

...contact the specialists individually (not the office managers) and talk to them about the problem face-to-face. You might be able to work something out with some of them...

I think BD has touched on most everything.... I also believe this where "Why salaries are for suckers" is not the case. At least, not as far as your patients are concerned.

A few points....
First, while time consuming, direct contact between FM/FP/PCP and specialist on most cases even those that are not charity care is a good standard practice. It can take some time but, IMHO, is worth it. My best mentors and most successful specialists made a point of, with rare exception, contacting/speaking with the primary care referral base physicians directly. If you are in this practice to begin with... with actually paying patients, the specialist will feel your need when you call about the charity patients. It seems to always work better to be partnering in care on the profit side before you come around for the hand-outs/pro-bono stuff.

Second, aside from local charities.... which maybe some organizations might consider fronting some cash/etc...., you will likely have to have your patients travel to big centers.... where physicians have salaries... i.e. the land of the "suckers".