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Loading ...From WSJ:
Weak Economy Could Mean Medicaid Pay Cuts for Doctors
Not long after an epic battle over Medicare pay, doctors are bracing themselves for cuts from state Medicaid programs.
Blame the weak economy. States, which fund much of Medicaid, have fewer tax revenues coming into their coffers. Meanwhile, as more people lose jobs with health benefits, they are more likely to sign up for Medicaid, which serves the poor.
The result: “Doctors’ fees could be on the chopping block if states can’t cover their costs,” reports American Medical News, published by the American Medical Association.
AMNews cites a report on state Medicaid programs from the Kaiser Commission on Medicaid and the Uninsured that found enrollment grew by 2.1% in fiscal 2008 after a 0.5% decline in 2007, while at the same time spending increased 5.3%, the fastest incline since 2005. States expect bigger increases in both enrollment and spending in 2009, according to Kaiser.
Cutting doctor pay is tempting because it creates savings faster than cutting benefits does, Vernon Smith, a co-author of the Kaiser report and a principal at the research and consulting firm Health Management Associates, told American Medical News.
Dumb. Really dumb.
I accept Medicaid in my practice, but have started to consider if it is really worth the small amount paid. We are one of the already dwindling number of offices accepting it.
So what effect would cutting Medicaid reimbursement have? Doctors like myself would withdraw from the program. My income does not depend on Medicaid, so I would see very little effect on my bottom line (in fact, it could increase as low-paying Medicaid patients are replaced with better-paying privately insured patients). Less doctors accepting Medicaid would worsen an already serious shortage of physicians available for these patients.
What is the result of decreased access to PCP’s? ER visits. A rise in the number of ER visits would be inevitable (especially as the patients are not themselves financially penalized for using the more expensive ER over a PCP). This would significantly raise the cost to the system and worsen the financial shortfall for the Medicaid program. Cutting reimbursement would be the equivalent of biting the cyanide capsule – it would result in sure collapse of the system.
Ironically, the best thing they could do would be to raise physician reimbursement for PCP’s. This would increase the number of PCP’s on the Medicaid roster and decrease ER visits.
This is not a “maybe” scenario – I am one of those physicians that would be pushed toward dropping Medicaid if my reimbursement went down. As much as I like some of my Medicaid patients (and I do like a lot of them), I can’t afford to work at a loss.
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