This is a very interesting discussion. It just goes to show you how regional medicine is. In my state, Medicare is the highest payer, whereas Medicaid pays approximately one half of what Medicare does. Therefore, you would have to see TWO Medicaid patients to equal the reimbursement of one Medicare patient. Thats one reason why a lot of physicians do not take Medicaid.
Another factor to consider is Medicaid patients tend to be often very difficult to deal with the tend to be the most demanding, the most needy and suck up a LOT of your time. And often they will be the first to want to sue you if something goes wrong. I don't take Medicaid in my practice.
In my state, most private HMOs and PPOs pay a percentage of Medicare. Blue Cross and Aetna pay about 80% of Medicare. Humana and United pays 75% of Medicare. The one saving grace about these particular companies is
that they send you patients and volume.
If you want, you could have a completely 100% Medicare practice as that would make the most financial sense as Medicare is the highest payer in my state. However, as a family physician , who is trained to see all ages and who desires to see a variety of patients, seeing the 65 and over crowd exclusively for the sake of maximizing my dollar would completely BORE THE HELL OUT OF ME. I have to enjoy what I do do. In terms of my tastes and preferences, I HAVE to have variety of population. Seeing only 65+ y/o "HONDA's" (hypertensive-obese-noncompliant-diabetics) all day/every day would drive me nuts. I don't mind seeing the 20+ y/o with acute bronchitis who needs a Z-pack. I get the SAME reimbursement for that visit as I would for a "HONDA". I see both HMO patients and Medicare patients. I even have cash paying patients. I pretty much charge them what Medicare would charge. Thus my seeing a cash paying patient is equivalent to seeing a Medicare patient.
In terms of getting physicians in an area to all agree on one billing/pricing scheme, that is a theoretical and conceptual IMPOSSIBILITY. That will never happen , and thus makes no sense harping about "If only physicians would ALL AGREE to do X, Y Z"...Remember, each physician is independent and autonomous. Even if you got a group of docs to agree on one thing, you will always have outlyers, who will choose to do something different. The analogy of herding cats is extremely valid when you are discussing physicians. Therefore , we need to look at the situation with a realistic eye.
One important thing we must always REMEMBER, (I mentioned it in the Family Medicine FAQ) please, please, please remember that just because you were smart enough to finish medical school does not mean you have the brains for business. M.D. does not equal MBA. Secondly , your ability to make relationships with other individuals is SO IMPORTANT in terms of the deals you're able to secure to financially benefit you and your practice. If you are a total schmuck with no social skills and can't get along with anybody, I do not care if you are top of the medical school class, went to Harvard, AOA, etc. If you do not have the necessary social skills to make good relationships with other physicians, no one is going to send you business , no one will want to work with you, and you will financially suffer.
Sorry for the rambling, I am glad we are able to bring out these issues out in the open so that everybody can learn from our different perspectives.
PEACE!!
-Derek
