Comments on: Biting the Cyanide Capsule http://distractible.org/2008/10/14/biting-the-cyanide-capsule/ Thoughts of a moderately strange (yet not harmful) primary care physician. Mon, 22 Mar 2010 11:18:13 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: m (2) http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2758 m (2) Wed, 15 Oct 2008 22:43:10 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2758 "Medicaid pay cut" seems redundant, somehow. “Medicaid pay cut” seems redundant, somehow.

]]> By: The Scrivener http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2754 The Scrivener Wed, 15 Oct 2008 12:05:52 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2754 Your case makes perfect sense. I really encourage you to write to your Congressman/Senator about it. When I worked in DC this summer, all the health insurance hearings I went to had economists or administrators as witnesses, and several of the Members of Congress stated that they wanted to hear from "the stakeholders" -- physicians and patients. It was the outcry from people like yourself and your patients that reversed the Medicare cuts this summer. The same can be done for Medicaid, if enough people care to write. Your case makes perfect sense. I really encourage you to write to your Congressman/Senator about it. When I worked in DC this summer, all the health insurance hearings I went to had economists or administrators as witnesses, and several of the Members of Congress stated that they wanted to hear from “the stakeholders” — physicians and patients. It was the outcry from people like yourself and your patients that reversed the Medicare cuts this summer. The same can be done for Medicaid, if enough people care to write.

]]> By: Ken O. http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2753 Ken O. Wed, 15 Oct 2008 08:38:04 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2753 Dr Rob's business case makes sense to me, and there's historical prescedent for the scenario he outlines, from when our Government cut NHS reembursement rates to dentists, and the majority of them responded by stopping NHS treatment. Dr Rob’s business case makes sense to me, and there’s historical prescedent for the scenario he outlines, from when our Government cut NHS reembursement rates to dentists, and the majority of them responded by stopping NHS treatment.

]]> By: Robert http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2752 Robert Wed, 15 Oct 2008 00:05:28 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2752 It's truly distressing to see that Medicaid is the first place where they plan to cut the budget. For your information, the defense industry is about to receive $487.7 billion worth of contracts, according to WSJ (<a href="http://online.wsj.com/article/SB122247197883080691.html" rel="nofollow">here</a>). ARGHH! It’s truly distressing to see that Medicaid is the first place where they plan to cut the budget. For your information, the defense industry is about to receive $487.7 billion worth of contracts, according to WSJ (here). ARGHH!

]]> By: Doctor Anonymous http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2751 Doctor Anonymous Tue, 14 Oct 2008 15:57:14 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2751 About a year ago, our practice went through the difficult discussion of whether to no longer accept medicaid. We went through all the pros and cons of this issue. Even though it meant letting go of a lot of great patients and families, our group decided to withdraw from treating medicaid patients a few months ago. I see those patients every day whether at the store or at soccer games. Of course some are angry about it, but the majority of them understand our decision. Also during that transition time, I tried to educate my patients on the state medicaid system. There are few medicaid accepting docs in this county - so access to care has become a major issue around here on the local level. Some of my patients are even getting involved in this election cycle, particularly in county and state office races - solely because of this medicaid issue. Finally, I do have hope that when our state medicaid system collapses, the rebuilt version will allow our practice (because of less hastles and possibly more payment) to see our patients again. About a year ago, our practice went through the difficult discussion of whether to no longer accept medicaid. We went through all the pros and cons of this issue. Even though it meant letting go of a lot of great patients and families, our group decided to withdraw from treating medicaid patients a few months ago.

I see those patients every day whether at the store or at soccer games. Of course some are angry about it, but the majority of them understand our decision. Also during that transition time, I tried to educate my patients on the state medicaid system. There are few medicaid accepting docs in this county – so access to care has become a major issue around here on the local level.

Some of my patients are even getting involved in this election cycle, particularly in county and state office races – solely because of this medicaid issue. Finally, I do have hope that when our state medicaid system collapses, the rebuilt version will allow our practice (because of less hastles and possibly more payment) to see our patients again.

]]> By: a family doc http://distractible.org/2008/10/14/biting-the-cyanide-capsule/comment-page-1/#comment-2750 a family doc Tue, 14 Oct 2008 15:55:40 +0000 http://distractible.org/2008/10/14/biting-the-cyanide-capsule/#comment-2750 Maybe they're not so dumb. Private practices are also a dwindling part the provider mix in many locations. The growing percentage of hospital based clinics are usually unable to drop Medicaid, either due to their mission or regulations. Many private practices will likely be dropping Medicaid anyway as the no copay Medicaid patients will not slow their demand for appointments while the paying patients either come in less often or switch to Medicaid if they lose their jobs. The rate Medicaid pays is only one factor determining the financial impact it has on a practice. While some of the Medicaid patients will go to the ER, many will simply defer care if they can't find a physician or if their physician's schedule is overwhelmed by too many patients. Access problems are a crude but effective way to save money or ration care. I'm not implying that this is a good thing, merely that the state Medicaid administrators may have already thought this through. They're in a tough spot. Maybe they’re not so dumb. Private practices are also a dwindling part the provider mix in many locations. The growing percentage of hospital based clinics are usually unable to drop Medicaid, either due to their mission or regulations.

Many private practices will likely be dropping Medicaid anyway as the no copay Medicaid patients will not slow their demand for appointments while the paying patients either come in less often or switch to Medicaid if they lose their jobs. The rate Medicaid pays is only one factor determining the financial impact it has on a practice.

While some of the Medicaid patients will go to the ER, many will simply defer care if they can’t find a physician or if their physician’s schedule is overwhelmed by too many patients. Access problems are a crude but effective way to save money or ration care.

I’m not implying that this is a good thing, merely that the state Medicaid administrators may have already thought this through. They’re in a tough spot.

]]>