Do We Want To Accept Medicaid?
Here's a recent news release:
Medicaid Physician Recognition Bill
Introduced in House
HR 3364 (which would recognize podiatrists as physicians under Medicaid), has been introduced in the House of Representatives. HR 3364 is a companion bill to S 1309, The Equity and Access for Podiatric Physicians under Medicaid Act.
HR 3364 was introduced today by Rep. Lee Terry, R-Neb. Cosponsors include Reps. Diana DeGette, D-Colo., Ed Whitfield, R-Ky., Bill Posey, R-Fla., and Brian Bilbray, R-Calif.
Both bills retain the same title and wording as previous years' bills and would recognize the services of podiatrists as physician services in the Social Security Act's Title XIX/ Medicaid statute. The law currently requires that physician services be covered by state Medicaid programs, but states may opt to cover "podiatry services" or not.”
(Source: APMA News Brief November 7, 2011)
In California, podiatrists are considered providers of a “voluntary” service (along with dentistry and optometry). I’m not sure what constitutes a “necessary” service, since podiatric medicine has been proven to decrease both the pedal complications and costs related to diabetes. Why wouldn't any insurance company want to improve their patients’ health while decreasing their own costs? It’s beyond me.
I work at a couple of county hospitals, and, in ways I’ll probably never understand, allow us to bill for Medi-Cal (the California version of Medicaid) only if we see the patient in the hospital. Reimbursement amount, of course, is another matter entirely.
Take, for example, another news release:
Feds Approve CA's Plan to Slash Medi-Cal Payments:
The Centers for Medicare and Medicaid Services (CMS) has given the go ahead to California's plan to cut reimbursement rates by 10% for a number of Medi-Cal providers. According to DHCS, CMS has allowed the state to make a 10% cut to:
- Reimbursements to a number of providers and outpatient services, including clinics, dentists, laboratories, optometrists, and durable medical equipment; and
- Freestanding nursing and adult subacute care facilities, as well as other nursing facilities.
Officials with California's Department of Health Care Services said the cuts are retroactive to June 1, meaning health care providers will have to return money to the state or have the funds subtracted from upcoming payments.
CMS has not decided whether to approve California's proposals to:
- Require beneficiaries to pay $5 copayments for physician visits and $50 copays for emergency department visits; and
- Limit beneficiaries to seven physician visits annually.
The state has withdrawn a request to cut Medi-Cal rates to hospitals and to children's medical providers after concluding that those reductions would hamper access to care."
(Source: California Healthcare October 28, 2011)
Why do we want to be part of a system that pays virtually nothing for a high risk community and continues to drop the reimbursements? I find only one reasonable argument why any podiatric physician would choose to accept Medicaid patients — assuming their state even allows it: the rest of the medical community sees them. When a DO or MD sees patients in the hospital, they’ll see Medicaid patients. It's simply part of the job to see all patients that are assigned, regardless of insurance. If we want parity, we need to behave in the same manner as those with which we want that parity. In your private office, feel free to choose your patients — that's a private office matter.
But if you’re going to take call or accept consultations at your local hospital, you shouldn’t limit the types of patients you’ll see. If you want to be part of your medical community, then you have to participate in the same manner as that community. I have been on staff at hospitals with podiatric physicians who refuse to see either Medicaid or uninsured patients, and this is looked on negatively by the hospital community. The question boils down to this: do you want to avoid Medicaid patients or do you want parity? We can’t have both.
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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