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. 😛