A Good Question

[DOnut]

Has anyone ever noticed that if you enter an upper middle class neighborhood, you can find an Ophthalmologist in almost any medical building. If, however, you are in a poorer neighborhood, ophthalmologist are few and far between. My question is, what is the advantage one would have by practicing in a upper-middle class neighborhood as opposed to a poor neighborhood? Say, for example, Dr. A performs 10 cataract surgeries on 10 patients with private insurance, and Dr. B. performes 10 cataract surgeries on 10 patients with medicare. What advantage, if any, would Dr. A have over Dr. B? Inquiring minds want to know.

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[Neurogirl]

Are you kidding? Guess you didn't know this but the fact is, reimbursement from medicare is embarrassingly low. This is the reason that the vast majority of physicians must limit the number of medicare patients they see. Some have completely stopped taking medicare. Before someone starts a flame war, please know that if a physician didn't limit her/his exposure to medicare, they would quickly go bankrupt. It's one of the governments dirty little (open) secrets. They know that the public will just blame physicians for their lack of access...the greedy bastards that we are.

 

[Annette]

Do you mean medicare(elderly) or medicaid(poor)?

 

[Careofme]

I'm definitely no expert but I'd say both are inferior in the amounts they reimburse when compared to a private insurance company!

Healthcare Law Prof Stookey would be proud.

care

 

[Jersey Girl]

I think she meant medicaid (poor). I am sure medicare does a not so hot job also, but medicaid is what's really bad. I work at an adult medical day center where every one has medicaid. So I hear talk about this stuff all of the time. Medicaid gives these poor people such a hard time with everything.

 

[md03]

Plus, middle and upper middle class people are more likely to pay any balance that's left if their insurance doesn't pay the whole amount (not unusual for private insurance). Yes, they have more money, but more importantly they generally feel more of a sense of obligation to pay their bills.

It is generally true that the vast majority of the poor on medicaid feel that they shouldn't have to pay anything at all for medical care. It's part of the entitilement mentality that seems to arise with years of dependence on government support.

I worked in a hospital based urgent care clinic associated with the ER prior to med school. The vast majority of the population was medicaid patients. Prior to that clinic opening (or during the hours that the clinic was closed), the patients had come to the ER for all kinds of inapproprate things...like head lice. They also tended to get really upset if they had to wait, yelling at the triage nurse. She said one day, someone yelled at her for having to wait (he'd been there less than an hour) and she apologized, saying they were dealing with an emergency (a code was going on, and in this rural hospital, that basically took the full attention of all ER staff). The man became really irate, saying "Every time I come here you are working on some kind of emergency! (go figure)

Anyway, medicaid patients don't generally think they should have to pay anything for medical care out of their own pocket. They come to the ER for lice, because if the have a prescripion, medicaid will pay for OTC lice treatments (no private insurance does that!!) Same is true of tylenol and ibuprofen. And, while yes, some people probably can't afford it, many are yacking on their cell phones, driving new cars, discussing the latest cable TV program. And many of these people simply don't think they should have to pay any balance on a medical bill not covered by insurance. (That's why you find so many people in the medical field get very cynical very fast)

 

[Neurogirl]

I meant both. Although medicaid is probably just as bad, I actually hear more complaints about medicare. The reimbursement for medicare was never great, but the balanced budget act of 1997 really screwed things up. Physicians were targeted for cuts and boy did they cut! During the first two year period, payments to physicians were cut by $20,000,000,000 (yes, that's right...20 billion) and they continue to make yearly cuts! When it was discovered that certain predictions and calculation rates were grossly inaccurate, the HCFA admitted their mistake, but we are STILL waiting for the corrections (plus, because the cuts are automatic, they continue)! Also, I'm fairly certain that everyone can FORGET about being reimbursed for the errors! To add insult to injury, many physicians felt forced to seek legal counsel to make sure they were in compliance with all the new rules and regulations designed to stop/prevent the fraud that was presumably rampant! One especially dirty tactic is the practice of notifying patients that a physician is SUSPECTED of fraud (BEFORE THEY ARE EVEN CONVICTED)!!!! AMNews reported the story of one physician who was accused of fraud. Of course he was found innocent, but the govt. refused to notify his patients of their mistake! Because of the notices, word spread and he lost not only medicare patients, but also alot of private pay patients. With decreasing reimbursement and mounting legal and administrative expenses (SOMEONE'S got to deal with all the extra paperwork!) many have said, enough is enough! Some have found that it's actually cheaper to treat medicare patients for FREE!

I don't know all that much about medicaid, except that in the past 10 years, the American Academy of Pediatrics in three different states have sued their respective states for failure to comply with various regulations. When it comes to reimbursement, I'm sure that they're probably just as bad, but because medicaid is administered at the state level you don't see all the arrogant, heavy handed tactices employed by the federally administered medicare. Also, because so many adults in the medicaid system have the above mentioned "entitlement mentality", many physicians have thrown in the towel and just stopped taking them (which is one reason so many of them end up in the ER). The only people really pushing for compliance and reform are pediatricians. For those of you who want to follow the continuing saga of medicare/medicaid, AMNews is probably the best resource. <a href="http://www.ama-assn.org/public/journals/amnews/amnews.htm" target="_blank">www.ama-assn.org/public/journals/amnews/amnews.htm</a> Also, it can be accessed online at no cost. Ok...I'm done ranting...for now.

 

[Whisker Barrel Cortex]

When I did my outpatient peds rotation in third year I was at a clinic that served 80-90% medicaid patients. The two doctors would usually schedule 80 patients a day with the hope that 40-50 would show up. This highlights one of the other issues physicans deal with when taking medicaid patients. Due to many factors that stem from their poverty (lack of transportation, inability to afford healthy food, lack of time, and just plain lack of caring) many of these kids were in poor health. The majority of parents that showed up to their appointments were very good caring parents, but that 20% that did not follow advice and the ones that failed to show up time after time were very frustrating.

Add to that frustration the miniscule reimbursement for these patients and it is no wonder that many docs don't take medicaid. I believe the reimbursement for a rountine office visit was 20 dollars. Most private insurance pays 45-70 dollars for the same visit.