Who out takes taking Medicaid Patients?

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LongSnow

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Currently not participating but just wondering what the experiences of those who do are. Is it viable?

Thanks!

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I see them, I actually get paid more for Procedures on Medicaid than MC pts.
about same on office visits. Though when I practiced in La. they would not pay for interventional pain procedures on Medicaid pts
 
Medicaid in AZ pays better than Medicare but I don't care for a lot of the patients. They tend to be entitled, drug seeking and litigous so I don't see them.
 
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I think it is published by Lax that 73% of Medicaid patients have opiate misuse in the pain clinic setting. My office (multispecialty group) does not take Medicaid.
 
take it and hate it, I usually fulfill my obligation to consult and workup pathology (if there is any) and then kick back to PCP with recs.
it's only viable if you work for a mega hospital/academic/VA facility with a shield of lawyers
 
1 new mcaid per week. Procedures often pay better than care

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I take it. It's a bit of a political issue for us. As others have mentioned, many of the younger patients are entitled, lazy, and narcotic seeking.
 
*mcare . But overall they pay 10% of charges on average.

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I take it. It's a bit of a political issue for us. As others have mentioned, many of the younger patients are entitled, lazy, and narcotic seeking.

We also "take it" for political reasons. However since I do not readily prescribe narcotics, and they are all told this multiple times when scheduling and arriving, and are all seen by my NP at 8 am, most don't show or go home when they realize they will not get what they came for.

"how can I help you"
"uhh, pain management, that's why I am here"
"we don't prescribe opiates..."

"well then what the hell do you do. This is a waste of my time..."
"I agree..."
 
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We also "take it" for political reasons. However since I do not readily prescribe narcotics, and they are all told this multiple times when scheduling and arriving, and are all seen by my NP at 8 am, most don't show or go home when they realize they will not get what they came for.

"how can I help you"
"uhh, pain management, that's why I am here"
"we don't prescribe opiates..."

"well then what the hell do you do. This is a waste of my time..."
"I agree..."

Almost identical interaction at my clinic - that's hilarious. We also see them for political reasons. It pays horribly for office visits, but pays more than any other payor for most procedures, so you just have to be really selective.
 
Almost identical interaction at my clinic - that's hilarious. We also see them for political reasons. It pays horribly for office visits, but pays more than any other payor for most procedures, so you just have to be really selective.

I hqve never seen Medicaid pay decently for procedures,
 
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I hqve never seen Medicaid pay decently for procedures,

In my area Medicaid doesn't pay for ANY procedures. You can imagine what a joy it is to
offer these folks ultram, flexeril, and a home excercise regimen because PT isn't paid for either.
 
I can't get PT paid for either, maybe 1 visit at most. And similar 'formulary' for pills - hydrocodone, oxy, mso4, tramadol, nsaids, flexeril ...
procedures - I can't get reimbursement numbers from admin, they have us on RVU and say we have a "good contract"
so it's all about patient selection, every now and then I'll get one that has legit pathology and concordant symptoms and is reasonable. but that's about 1/month. the rest get returned to PCP or self discharge
 
Thanks for all the input - I was looking at my states Medicaid (Virginia) fee schedule - it was like 80% of medicare.

Is reimbursement more like medicare?

Or is it more like workmans' comp where everything has to be approved?

Or do you just just never seem to get paid unless your secretary really works for it?
 
Thanks for all the input - I was looking at my states Medicaid (Virginia) fee schedule - it was like 80% of medicare.

Is reimbursement more like medicare?

Or is it more like workmans' comp where everything has to be approved?

Or do you just just never seem to get paid unless your secretary really works for it?

i can tell you right now, if you dont "HAVE" to take it, dont.

nothing good can come of it. at 80% medicare, with nothing but drug seekers and abusers, that will get "procedures" as long as you fill their vicodin. They will not show up, be late, require lots of time and resources...

if you were a cardiologist, that would be different, you cant fake the plaque and obstruction...
 
in my experience, >90% of medicaid are psychiatric cases with all kinds of secondary gains (financial primarily).... I pick and choose my medicaid cases based on reviewing the records (ie: if they are on medicaid because of terminal CA, etc as opposed to 22 yo obese, smoker, drug user, w PTSD and pain all over)...
 
in my experience, >90% of medicaid are psychiatric cases with all kinds of secondary gains (financial primarily).... I pick and choose my medicaid cases based on reviewing the records (ie: if they are on medicaid because of terminal CA, etc as opposed to 22 yo obese, smoker, drug user, w PTSD and pain all over)...

Saw one this am, 28y/o male with an L5/S1 HNP and Axial Back Pain. Referred by a surgical colleague for consideration of an ESI. ESI is not funded by his his insurance and he isn't really interested in one anyway. Exam was normal but his "life is ruined" b/c of his back pain. He shared that he felt "completely hosed" and "incapacitated" by his pain. While the Vicodin and Percocet "arn't working" he does not want to stop them. I suggested he do so anyway. Oh, and by the way he has a medical marijuana card.
 
why is otherwise healthy 28 yo on medicaid?
 
Saw one this am, 28y/o male with an L5/S1 HNP and Axial Back Pain. Referred by a surgical colleague for consideration of an ESI. ESI is not funded by his his insurance and he isn't really interested in one anyway. Exam was normal but his "life is ruined" b/c of his back pain. He shared that he felt "completely hosed" and "incapacitated" by his pain. While the Vicodin and Percocet "arn't working" he does not want to stop them. I suggested he do so anyway. Oh, and by the way he has a medical marijuana card.


Just curious, because my state (thankfully) does not allow medical marijuana - what exactly do you tell people who request opioids and have a medical marijuana card? do they use the "its legal" argument, and the retort is "not federally"? obviously, someone wrote that patient of yours vicodin and percocet and he has a maryjane free pass...

are some pain clinics in some of those medical marijuana states allowing concomitant use of opioids and marijuana?
 
Just curious, because my state (thankfully) does not allow medical marijuana - what exactly do you tell people who request opioids and have a medical marijuana card? do they use the "its legal" argument, and the retort is "not federally"? obviously, someone wrote that patient of yours vicodin and percocet and he has a maryjane free pass...

are some pain clinics in some of those medical marijuana states allowing concomitant use of opioids and marijuana?

My state is next to allow "medical" MJ. It will likely pass this year. I will not allow opioids and MJ together, any more than I would allow my chronic opioid patients to drink alcohol. The two have additive effects that cannot not be harmful together.

Many docs choose to ignore MJ use, whether in a state that has legalized it or not. The federal law is clear. The battle over MJ and opioids together is not clear.
 
what exactly do you tell people who request opioids and have a medical marijuana card?

No.

IMO those physicians that write MJ scripts should be held to the same standards as the rest of us who prescribe controlled substances: routine f/u, UTS, & a discrete prescribed amount. This should be mandated by our state medical boards.
 
No.

IMO those physicians that write MJ scripts should be held to the same standards as the rest of us who prescribe controlled substances: routine f/u, UTS, & a discrete prescribed amount. This should be mandated by our state medical boards.

how do you prescribe a discrete amount of MJ?
 
how do you prescribe a discrete amount of MJ?

Example: 2g THC qd sig 1mo supply no refills. If you are an MD/DO who prescribes and you can't do it with that level of certainty then you should not prescribe. If a plant supplier can't give you that level of certainty about dosage then no state approval for that supplier.

I've said before, I could give a rats arse whether or not it's legalized, but this big medical sham is a huge black mark on our profession.
 
Example: 2g THC qd sig 1mo supply no refills. If you are an MD/DO who prescribes and you can't do it with that level of certainty then you should not prescribe. If a plant supplier can't give you that level of certainty about dosage then no state approval for that supplier.

I've said before, I could give a rats arse whether or not it's legalized, but this big medical sham is a huge black mark on our profession.


my point exactly, and algos has railed against this as well. there is no standardization of dosages. no purity testing, etc. there are better drugs for glaucoma, anorexia, chemo-induced nausea. i cant see how a doc can legitimately prescribe it, regardless of how big a pothead they may be
 
my point exactly, and algos has railed against this as well. there is no standardization of dosages. no purity testing, etc. there are better drugs for glaucoma, anorexia, chemo-induced nausea. i cant see how a doc can legitimately prescribe it, regardless of how big a pothead they may be

let me rephrase my stance -

with the exception of synthetic marijuana, even if my state does start to allow medical marijuana, i will not prescribe it, and i think any pain physician that is providing opioids is taking impossibly huge legal risks if he tries to become a marijuana provider.

im just trying to get the benefit of experience from those of you who have been talking to patients who come into the office and want their cake and their frosting (and pancakes and leftover pizza and chips and other munchies) too..
 
I have seen a couple of failed fusion pts on opioids and who openly said they smoke a few joints per week with medical certificates (legal in my state). They were very happy with their pain control and were sent to me just to rubber stamp their regimen. I did.

It's just too grey for me to call the prescribed use of a state sanctioned drug "substance abuse". I would rather have someone smoking pot than doing the other concoctions like valium, fioricet, soma, etc.

Of course, that's assuming no other red flags...

I would never prescribe MJ, although I did prescribe marinol for the first time last month...
 
I have seen a couple of failed fusion pts on opioids and who openly said they smoke a few joints per week with medical certificates (legal in my state). They were very happy with their pain control and were sent to me just to rubber stamp their regimen. I did.

It's just too grey for me to call the prescribed use of a state sanctioned drug "substance abuse". I would rather have someone smoking pot than doing the other concoctions like valium, fioricet, soma, etc.

Of course, that's assuming no other red flags...

I would never prescribe MJ, although I did prescribe marinol for the first time last month...

So when you say they were "very happy", do you mean that (at least) some of these patients were able to return to work ?
 
So when you say they were "very happy", do you mean that (at least) some of these patients were able to return to work ?
Returning to work is an abstract concept that few of my patients would understand. I had a patient tell me yesterday how much money he would lose in benefits if he worked. I swear it. Yesterday...
 
If I had a HS education, or equivalent (or less), and was given the option of:

A) Get up at 5:30 am M-F, to drive my 15 yo pickup to a factory so I would work the next 9-10 hours in the heat or cold, doing manual labor opportunity for a boss I hated and a company I did not respect, for $12-15/hr, for the benefit of kids who didn't appreciate it and a spouse who wants more outta life, or

B) the opportunity to sit at home 24/7, watch TV and play video games, get monthly disability checks, daily opioids and state-sanctioned doobies,

I can tell you what I'd be doing with my life...
 
If I had a HS education, or equivalent (or less), and was given the option of:

A) Get up at 5:30 am M-F, to drive my 15 yo pickup to a factory so I would work the next 9-10 hours in the heat or cold, doing manual labor opportunity for a boss I hated and a company I did not respect, for $12-15/hr, for the benefit of kids who didn't appreciate it and a spouse who wants more outta life, or

B) the opportunity to sit at home 24/7, watch TV and play video games, get monthly disability checks, daily opioids and state-sanctioned doobies,

I can tell you what I'd be doing with my life...

Yes, I suppose this is true.

However, some of these blue collar workers can make pretty good coin: welders, plumbers, carpenters, etc. You don't have to be a rocket surgeon to make bank. My contractor (who happens to also be a patient of mine ) is a perfect example. This guy is a workhorse - he must work 60 -70 hours / week , 6 days / week ; I'm pretty sure he makes more money than I do, although he runs his own company (by a significant margin if my reno bills are any measure of his billings). Super nice guy.

The ones who actually go back to work, or are motivated to get better keep me going.
 
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Yes, I suppose this is true.

However, some of these blue collar workers can make pretty good coin: welders, plumbers, carpenters, etc. You don't have to be a rocket surgeon to make bank. My contractor (who happens to also be a patient of mine ) is a perfect example. This guy is a workhorse - he must work 60 -70 hours / week , 6 days / week ; I'm pretty sure he makes more money than I do, although he runs his own company (by a significant margin if my reno bills are any measure of his billings). Super nice guy.

The ones who actually go back to work, or are motivated to get better keep me going.

do they have medicaid in canadia? or something similar?
 
do they have medicaid in canadia? or something similar?

i think you are asking if they have welfare. everyone has medicaid in canadia.

im guessing they do, but the system isnt raped like it is here in the states for one reason or another
 
i think you are asking if they have welfare. everyone has medicaid in canadia.

im guessing they do, but the system isnt raped like it is here in the states for one reason or another

no i mean, is it a completley single payer system, or is there private insurance and then governmental insurance. Or is it everyone get the govt insurance, and then you can pay cash if you want for special treatment. I am legitimately asking... i have only gone to canada to ride snow, and play illegal concerts without the authority of the canadian government. I must have taken at least $200 dollars in undeclared profit out of that country by playing huge concerts to the 30-40 canadiens who know who we were.

i joke, but i LOVE canada.

I love tim hortons.
Grant Fuhr
Whistler
Bieber (oh wait....)
 
canada, pleazze
We sent out evites to the last war and 2 guys showed up
 
canada, pleazze
We sent out evites to the last war and 2 guys showed up


Canada's military was active in every theatre of war, though most battles occurred in Italy,[4] Northern Europe,[5] and the North Atlantic.
Over the course of the war, 1.1 million Canadians served in the Army, Navy, and Air Force. Of these more than 45,000 lost their lives and another 54,000 were wounded.[6] The financial cost was $21,786,077,519.12, between the 1939 and 1950 fiscal years.[7] By the end of the War, Canada had the world's fourth largest air force,[8] and third largest navy.[9] As well, the Canadian Merchant Navy completed over 25,000 voyages across the Atlantic.[10] Canadians also served in the militaries of various Allied countries.

source: http://en.wikipedia.org/wiki/Military_history_of_Canada_during_World_War_II
 
Canada's military was active in every theatre of war, though most battles occurred in Italy,[4] Northern Europe,[5] and the North Atlantic.
Over the course of the war, 1.1 million Canadians served in the Army, Navy, and Air Force. Of these more than 45,000 lost their lives and another 54,000 were wounded.[6] The financial cost was $21,786,077,519.12, between the 1939 and 1950 fiscal years.[7] By the end of the War, Canada had the world's fourth largest air force,[8] and third largest navy.[9] As well, the Canadian Merchant Navy completed over 25,000 voyages across the Atlantic.[10] Canadians also served in the militaries of various Allied countries.

source: http://en.wikipedia.org/wiki/Military_history_of_Canada_during_World_War_II

Just jerking your chain ghost dog. I love Canada. Its the only place you can go where people apologize when you step on their feet. :laugh:
 
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