Attracting Medicaid Patients

[jbomba]

---

Members don't see this ad.

If one were to take medicaid in a private practice, what would be good methods to ensure this patient base knew about the practice? I'm looking to start a tele practice in another state (far, far away from CA) where medicaid pays exceptionally well and I can perhaps feel like I am making more a difference as I imagine this patient population has had very little access to high quality psychiatric care.

I've never really considered medicaid until recently, so curious if there are any specifics to keep in mind as I try to grow this patient panel.

 

[Merovinge]

LMAO, if you see kids in my state and take Medicaid I could have your practice full in a week. Our academic centers have wait lists in the 6-12 month (and sometimes longer) range and are typically the main option. There are some publicly funded options but many are not able to make the commute to access these. I would just touch base with any academic center contact, this is one of the rare cases where people are actively looking to give patients away. Unless this exceptionally well pay has actually made this population scarce, I've never heard/lived in such a location.

 

[jbomba]

LMAO, if you see kids in my state and take Medicaid I could have your practice full in a week. Our academic centers have wait lists in the 6-12 month (and sometimes longer) range and are typically the main option. There are some publicly funded options but many are not able to make the commute to access these. I would just touch base with any academic center contact, this is one of the rare cases where people are actively looking to give patients away. Unless this exceptionally well pay has actually made this population scarce, I've never heard/lived in such a location.

Gotcha. Unfortunately (or maybe fortunately) I don't see kids. This is in Montana, so obviously low population, but also very low psychiatrist population. I believe they are #2 in fewest psychiatrist per capita. Medicaid is paying better than "good" private payors here in CA.

 

[comp1]

I just cannot imagine the OP has a common problem...

 

[theduderino]

Interesting idea. I'd first consider the systems factors around how you can provide high quality remote care in this particular patient population and the potential issues you'll have as a solo practitioner vs working with alongside care coordinators, therapists etc. This will inform your inclusion criteria for patients and as an extension where it makes sense to try to market yourself. Think about IOP/PHP/inpatient centers to refer to (and receive referrals from), same with PCPs and therapists. I'd start to build a network to figure out the landscape and then use those connections once you're up and running. I'd also get in touch with whoever administers medicaid for behavioral health in the county of interest and set up a meeting. In some places, the administrator varies by county and reimbursement rates vary significantly. I don't take medicaid but in my particular county it pays a lot more than commercial insurance; neighboring counties pay a lot less.

You'll also need to think about the regulatory environment around medicaid. It's stricter in general as compared to private insurance and certainly stricter than private pay in terms of documentation requirements etc. In my county, medicaid won't contract unless you have a physical location available to see folks in person.

If you're serious about this and it's financially worth it I'd probably pay a local person to consult with (maybe an experienced medical director or director of a behavioral health organization). This seems like a ton of work if it's only going to be a sliver of your overall schedule.

 

[Candidate2017]

If one were to take medicaid in a private practice, what would be good methods to ensure this patient base knew about the practice? I'm looking to start a tele practice in another state (far, far away from CA) where medicaid pays exceptionally well and I can perhaps feel like I am making more a difference as I imagine this patient population has had very little access to high quality psychiatric care.

The Medicaid psychiatric population has access to the latest, greatest, and most expensive medications. They just need to take their antipsychotics/mood stabilizers, stay off substances, not antagonize friends/family/public, and stay out of jail. It's like kindergarten: follow directions, don't ingest stuff that's not food, play nice with others, keep your hands and feet to yourself. It's not that hard, but somehow it is. They may lack access to large numbers of psychiatrists but that's because of the above.

Even with high rates, I can't see how a Medicaid population won't bankrupt a PP. They require lots of resources better funded/wasted by tax dollars at CMHCs. Who will answer after hour crisis calls? Who will petition psychotic or suicidal patients? Who will testify? Who will coordinate care when patients are admitted/discharged from inpatient ("Yeah doc, I was hospitalized. I was fine, they made some stuff up. They said something about my EKG and liver, gave me a shot, and some green pills. I don't want to take those meds."). Noncompliance and no show rates will also be high.

Juice isn't worth the squeeze.

 

[ObsequiousAplomb]

I have been wondering about this as well. I was hung up on the problem of attracting medicaid patients who would be appropriate for a solo tele practice for Montana and realized it would need to be part of something else. Like an add-on to a psychiatrist there or as a tele role within a PCP's office or part of an organization. All of those would take some of that sweet Montana Medicaid pay from you, but their support would be worth it to make it work. I hear the locums rates are great in Montana. I imagine plenty of these clinics are staffed through them. I imagine they suck enough that enough other people haven't acted on this idea before us.

 

[jbomba]

The Medicaid psychiatric population has access to the latest, greatest, and most expensive medications. They just need to take their antipsychotics/mood stabilizers, stay off substances, not antagonize friends/family/public, and stay out of jail. It's like kindergarten: follow directions, don't ingest stuff that's not food, play nice with others, keep your hands and feet to yourself. It's not that hard, but somehow it is. They may lack access to large numbers of psychiatrists but that's because of the above.

Even with high rates, I can't see how a Medicaid population won't bankrupt a PP. They require lots of resources better funded/wasted by tax dollars at CMHCs. Who will answer after hour crisis calls? Who will petition psychotic or suicidal patients? Who will testify? Who will coordinate care when patients are admitted/discharged from inpatient ("Yeah doc, I was hospitalized. I was fine, they made some stuff up. They said something about my EKG and liver, gave me a shot, and some green pills. I don't want to take those meds."). Noncompliance and no show rates will also be high.

Juice isn't worth the squeeze.

I'm imagining you would still screen patients, even more thoroughly than normal.