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NYT: Doctors Refuse Medicaid Patients!

From a seemingly gobsmacked New York Times:

With Medicaid Cuts, Doctors and Patients Drop Out

By KEVIN SACK

March 15, 2010

FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

What a laugh.

As we know, the ‘healthcare reform’ package currently being rammed through Congress effectively requires far more drastic cuts to Medicaid (and Medicare).

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a radical left] research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

All of which will change, when under ‘healthcare reform’ the White House will be in charge of setting eligibility, benefits and most importantly, the payment for service rates.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults

[S]urveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics

The New York Times makes a great case against the current ‘healthcare reform,’ without realizing it. For in the final analysis, Obama-care is really nothing more than Medicaid expanded to cover first the uninsured, and then eventually, all of us.

What these poor souls on Medicaid face we will all be facing in ten years – or even sooner, once private insurance companies have been completely driven out of business.

And then stories like this or worse will become commonplace, just like there are in every country that enjoys socialized medicine.

By the way, note the exotic names of the doctors in the article. Even doctors trained in the third world are rejecting Medicaid patients.

This article was posted by Steve Gilbert on Tuesday, March 16th, 2010. Comments are currently closed.

24 Responses to “NYT: Doctors Refuse Medicaid Patients!”

  1. GetBackJack

    I’m shocked, shocked I tell you.

    /s off

  2. Mithrandir

    Wow, a government program that doesn’t work? The doctors aren’t getting paid? Well, then all the doctors need to work for the government (which they will) so that they can’t reject anyone–ever! I wonder how many doctors eventually quit, then we are left with the doctors who are just as lazy and uncaring as the other gov’t workers are. . .

    This is all going to implode, especially when people wind up dying because of lack of services, inadequate doctors, lack of medicine. You wait when someone’s mother or kid dies because of all this. There will be an large up-tick in people ‘going postal’ I suspect……(shudder!)

  3. proreason

    Why doesn’t some “journalist” add up the number of deaths from ObamyScare?

    Over the 10 years of taxes and 6 years of “benefits” (i.e., cram-downs), I’ll bet any objective measure would be in the millions.

    Probably tens of millions.

  4. Reality Bytes

    My Dad’s doctor told me “So we decided not to beat a dead horse.” when I made the decision for my father that he had had enough. BTW – notice how we didn’t need Obama or anyone else to make that “smart decision” as Obama put it when it came to Pop’s end of life decision.

    Imagine the medical profession’s attitude when they start being treated as postal workers.

    And you thought “Going Postal” was bad?! Wait till “Going Doc” catches on.

  5. bousquem

    I remember doing a rotation for my college at a large hospital in Vermont. Starting the beginning of this year they were no longer taking elective surgery patients with NY medicaid as they were paying nothing of the hospitals cost. The past couple of years had seen the payment to the hospital of the cost of the surgery and care go from like 40% to 20% to 8%, and finally 0%. I’m waiting to see the goverment mandate that to be in business the doctors must take as many medicaid patients as come in the door, regardless that the office will then go out of business as thehe goverment won’t pay for the care.

    Also I saw that Walgreens is no longer taking new medicaid patients in Washington state as the reimbursement rate just keeps dropping more and more. Just another example of how goverment run healthcare is not going to make things better.

  6. confucius

    How do you know the doctors with the “exotic names” were “trained in the third world”?

    The Michigan medical board’s website has no information.

    • confucius

      Dr. Saed J. Sahouri got his medical degree from the Medical College of Ohio and did his postgraduate training in Internal Medicine at St. Joseph Mercy Hospital.

      Dr. Nita M. Kulkarni got her medical degree from the University of Michigan Medical School and did her postgraduate training in Obstetrics & Gynecology at Rush Presbyterian.

      Dr. Bobby B. Mukkamala got his medical degree from the University of Michigan Medical School and did his postgraduate training in Otolaryngology at Loyola.

      Dr. Kiet A. Doan got his medical degree from the Western University of Health Sciences and did his postgraduate training in Surgery at Genesys Regional Medical Center.

      All of the medical schools and postgraduate training programs are located in the United States of America.

      (Source: http://www.vitals.com)

    • Steve

      Thanks, Confucius. — Still, I think it was a reasonable assumption.

      In many parts of the country only the more dodgy doctors will take Medicaid patients.

    • confucius

      I accept Medicaid patients. So do other family members who are physicians. (And for the record, we were all born, educated and trained here in America. Moreover, our elders emigrated to America legally.)

      My primary care physician also takes Medicaid.

      It is likely, however, that as physicians opt out of Medicaid (and Medicare), the first ones to leave will be the good ones and the last ones dodgy–if ever.

      I witnessed this shakeout when HillaryCare caused hospitals to clamp down on expenses. This resulted in the departure of competent nurses and allied healthcare professionals. The incompetent and the lazy stayed as they had nowhere else to go. As you can guess, this created a dangerous environment.

      Of course, there are exceptions. Nevertheless, ObamaCare will likely only accelerate this downward trend.

    • proreason

      the relentess and overwhelming pressures placed on healthcare by government (and others) can only only accelerate this trend.

      The direct costs are bad enough. Premiums will double in a few years.

      But the indirect costs, as you point out, will be even greater.

      - Many thousands of people will die earlier than they should
      - Life expectancies will decrease
      - People will suffer with conditions that could have been alleviated.
      - New medical breakthroughs will come to a grinding halt (as they largely have already outside the U.S.)

      It will be much worse than Europe or Canada. Those systems were not FOUNDED on corruption.

    • jobeth

      “I witnessed this shakeout when HillaryCare caused hospitals to clamp down on expenses. This resulted in the departure of competent nurses and allied healthcare professionals.”

      Confucius…

      You are right on with that statement. As a critical care Respiratory Therapist in large University teaching medical centers for 15 years, I saw a huge change in our ability to safely care for our patients.

      Our work load increased by 2 1/2 times in that 15 years. Attrition and reworking ‘work units’ per procedure to a lower value allowed the hospitals to require us to do more and more We just couldn’t humanly get to everyone.

      To the doctors anger (and rightful anger) we had to prioritized our treatments. There were many times patients didn’t get ordered treatments due to under staffing …and that due to the tight reimbursement schedule.

      I remember one night I had two side by side patients in the ER. One crashing and one who couldn’t be ventilated. It was critical that I be at both besides and actively working with both patients at the same time. and both sets of Doctors were demanding me at each beside. Either or both of these patients could have died because we needed another therapist and I was “IT”. I was the only one. Never mind my floor patients and their treatment orders.

      These situations come directly from the ever tightening fee structure from government health care payments. Being large teaching hospitals we got more than our fair share of indigent patients so we got the sickest of the sick but got less reimbursement for it than the so called “better” or “nice” hospitals that catered to those with insurance.

      And even though we know those hospitals were supposed to take everyone…they knew full well how to “dump’ their non payers. We couldn’t. We were the last stop.

    • confucius

      Hi jobeth.

      Regulations required my hospital have at least three full-time respiratory therapists. We had only one. There were many days (and nights) when I helped him manage ventilators and blood gases.

      6 months before JCAHO inspection, the hospital hired two. 6 months later, the hospital terminated them.

      This was 10 years ago.

      Now imagine what it’ll be like when ObamaCare passes.

    • jobeth

      confucius….

      “Them” were the days my friend…. Kidding…sort of…

      I left in Dec 2000 from two blown knees and a breast CA issue (now cured thankfully). I blame my constant running for the knees. but try to get comp for that and they will laugh you right out of the place.

      I digress….You mentioned the two fired therapists…and I know that situation well. Cry as we might we were told no new hires. They got by the mandates for therapists by reworking the ‘work units’ per procedure.
      I expect doctors have experienced a bit of that slight of hand as well per the government.

      My own GP, who is really good…and who has an “exotic”name by the way, must work on such a tight in/out schedule I don’t know how he does it. I travel 2 hours each way to see him because he is that good. Even with the time pressure. He’s found a couple of obscure conditions I had no one else picked up on. If I had not had that test my bones would still be being robbed . (parathyroid)

      Something I can expect won’t happen often in the future with even more pressure on the docs to see more people and test less.

      I also remember how we had to accept all comers in the units. Our units had about 16-18 beds each. The nurses were assigned by the patient acuity meaning once a certain number of patients and nurses had been met per acuity the unit closed to new patients regardless of the number of empty beds….or they would have to get another nurse. Not so with RT. If it rolled in the door….they belonged to us. No new RT to help. While we were limited to 6 vents there were often times we had up to 10, That was flat out scary. Mistakes happen under those conditions and people get hurt.

      I’ve spoken to old friends and they said things have gotten worse. I’m glad I’m out now and don’t advise anyone to take up any kind of medicine in the future. The jobs will go crying for employees but I can promise the pressure and serious responsibility will cause quick burn out and/or serious health care mistakes.

      It’s scary.

    • confucius

      Hi jobeth.

      Matters worsened at my hospital too.

      Many of the older and more experience staff–a.k.a. competent–left. The incompetent ones stayed, and administration filled the openings with new graduates.

      You can imagine the ensuing problems.

      A few months after the incident I described earlier, the medical ICU somehow became staffed with nurses who didn’t know how to manage and interpret invasive monitoring. When I and the other chiefs discovered this, we convened an emergency meeting with senior mangagement.

      Management’s answer was for the doctors to teach the nurses. (I know what you’re thinking. If the units were in better condition, I would have sent a few there.)

      Our answer was to excuse management and put the hospital on bypass. By nightfall, we had transferred or diverted as many patients as possible. We then worked the ICUs ourselves until the last critically-ill patient was out.

      That lasted about two weeks, and I was exhausted.

      A few months after that, management surprised the nursery with a neonatal high-frequency jet ventilator. Apparently, a family practitioner with no experience in high-risk obstetrics wanted to start delivering babies younger than 34 weeks gestation.

      Never mind that the nursery hadn’t been approved by the state to perform such risky deliveries. Nursing had no experience with such deliveries, RT had no experience with such ventilators and the hospital didn’t have a board-certified neonatologist on staff.

      Management’s solution was for me to personally take care of the preemie because I had experience with adult jet ventiators.

      My solution was better. I quit.

      Over the next two years, 1/3 of the medical staff and 1/2 of the hospital staff left.

      The hospital is now up for sale.

    • proreason

      My solution was better. I quit.

      Which is why a black market will arise with ObamyScare.

      Doctors who can quit, will quit, but since they are doctors they will continue to be doctors once in a while, or perhap regularly.

      Not officially and criminally, but they won’t be able to help themselves. They are trained to help people, and it’s in their blood. Many will not accept money. Some will.

      And then there will be the Granny Clampetts who will rush in with dangerous amounts of knowledge.

      It’s going to be ugly.

  7. Right of the People

    My mother-in-law has terminal kidney cancer. She’s 76, only has Social Security for income and has been rejected for medicaid. The rejection letter says she makes too much to qualify and I can’t even get anybody on the phone to explain their logic. I guess we don’t have to worry about her doctor not taking medicaid patients.

    • MinnesotaRush

      God’s good grace to your mother-in-law and your family through this hardship, Right of the People!!!

      I’ll add ya’ all to my prayer chain.

      God Bless!!!

    • Mithrandir

      That’s the next phase of the playbook: reject people for medical care, then don’t answer the phone….

    • jobeth

      Righ Of The People

      Shouldn’t your mother in law have MediCARE? I am wondering why she even needs to mess with medicAID.

      She should qualify if she is on SS.

  8. MinnesotaRush

    Heard of the Dr that will continue to take the Medicare/Medicaid patients; but will ask the patient to pay the approved amounts when seen, and then THE PATIENT can submit for payment from the gov.

    Watch that catch on …

  9. Reality Bytes

    I wonder how many Americans will start going to the vet for healthcare.

    • confucius

      Interesting question.

      Vets work on similar principles and use similar techniques. They also generally don’t take insurance.

    • proreason

      Remember Granny Clampett from the Beverly Hillbillies? She viewed herself as a doctor.

      There will be thousands of Granny Clampett’s in a few years if the cram-down passes.

      I wouldn’t be surprised if most people don’t start using them.

      One thing is for absolute sure…..a thriving black market will quickly arise for medical care.

  10. Reality Bytes

    Black Market?! Ironically appropriate paradox don’t you think Pro?




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