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NYT article about Medicaid

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8 years 4 months ago #80220 by joyfulMD
For the reimbursement figure, the paper cites Illinois Department of Healthcare and Family Services, Physician fee schedule key revised 7-01-09.

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8 years 4 months ago #80237 by AnnaM
From the fee schedule as of 4/11:

99213-$28.35
99214-$42.50
99215-$48.00

There are add-on reimbursements for a few codes (99213, 99214, and the well-child codes) that a doc could qualify for if they became a registered Maternal-Child Health Primary Care Provider. I was on one of the local committees that explored the problem of low reimbursements for maternal-child stuff, back in the day, which eventually led to somewhat enhanced rates for pregnancy care. The state government was pretty much forced to raise some of the reimbursements because NO ONE would see kids or pregnant women on Public aid. If I remember correctly, medicaid was paying less for a full 9 months of maternity care than the federal government was paying for the toilet seats on military transport aircraft. I kid you not.

Currently, for a new patient at the highest level (99205), the state reimburses $70.85, plus a whopping extra $3.25 to a registered MCH provider. 99205, for those who don't have any training in coding, would be a new kid who you've never seen before who comes to your office with insulin-dependent type I diabetes out of control, with an acute infection on top of that, or a new patient who comes to your office acutely suicidal, or with new-onset psychosis.

The enhanced reimbursements are not available to specialists, of course, because it is left up to the PCP to spend her limited precious time on the phone trying to find a specialist to see a kid for 30 bucks.

Think about this the next time you get the bill from your plumber or your auto mechanic.

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8 years 4 months ago #80238 by AnnaM
Re: depression: to me, "severe depression" in a child would be a kid who is overtly suicidal. That would be treated in the ER, because there is no way I could get a psychiatrist to see the kid on an emergent basis from the office.

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8 years 3 months ago #80504 by residentmom
My office does not take medicaid currently. My prior office did, and I can tell you for a fact that many specialists have 2 waiting lists- one for private pay patients, and one for medicaid. Yes, if I call someone I know personally and say its an emergency, I might get my patient in... but then again I might not. Consider that medicaid in most states pays less than it actually costs to see the patients, and it is essentially charity care. We would all go out of business if that was our only payor. In AnnaM's scenario above, you are being paid $48 to see a visit that is presumed to take a minimum of 25 minutes face to face, when billed based on time... so you can see 2 of those an hour, for the whopping payment of $96. That would not even cover the staff salaries for that hour at my office, much less mine, the power, the supplies, etc. Medicaid is a travesty for its patients, in virually all aspects, and I don't think loading even more unsuspecting patients into it will help.

ResidentMom<br /><br />"If you bungle raising your children, I don't think whatever else you do well matters very much." --Jackie O.

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8 years 3 months ago #80505 by residentmom
And don't even get me started on TriCare, the system with which we torture our military, veterans, and their families. Risk your life for your country and get free medical care! But only if you are willing to drive 60+ miles to an approved provider and wait weeks to months for all referrals and services... it's truly heinous.

ResidentMom<br /><br />"If you bungle raising your children, I don't think whatever else you do well matters very much." --Jackie O.

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8 years 3 months ago #80507 by Doc201X
IMHO, not taking ANY medicare/medicaid patients is just concierge medicine "lite".

I certainly understand that a privately run practice can't possibly live off medicare/medicaid patients alone, but if every PP would agree to serve say 20% of these types of patients, wouldn't medicine in general be better off in the long run?

My Scientist/Physician Journey
www.Doc201X.blogspot.com

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