Caller Bill Knows Medicaid Is Broken

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Mandeville, LA – Exclusive Audio and Transcript – Here’s a quote from Bill, a doctor in Atlanta, who often sees Medicaid patients in the Emergency Room but not in the office, for the rest with Bill, check out today’s audio and transcript, “From the standpoint of Medicaid, Medicaid will fight you tooth and nail on any penny.  The reimbursement is poor already.  By the way, at the end of the year, and it’s now coming up about that time, I will probably get a letter from my state saying: Medicaid funds are now empty.  We will hold all payment for the next 30, 45 days, etc.  How in the world can anyone run a business when they’re paying on credit for two months?  This is the problem.  The translation to the overall healthcare system is that when all these individuals are seen in an emergency care setting, emergency rooms are overrun.  When emergency rooms are overrun, you have to staff your emergency room with people that are probably not as highly trained as you would want because you just need personnel to just take care of the patients.  When that happens, you start relying on medical testing, not on physical exam or history taking because you don’t have the time.”

 

Begin Mike Church Show Transcript

Mike:  Let me get back to Bill in Atlanta.  Bill is probably busy and he’s got to get back to his patients.  Bill, let’s finish up with this Medicaid nonsense that Krugman was writing about in the New York Slimes.  You are a doctor.  You were saying that you can’t see or don’t see Medicaid patients in your office but you will see them in an emergency room.  I just wanted to give you a chance to flesh that out a little bit.

Caller Bill:  Sure.  If I have a responsibility to the hospital and the emergency room, certainly we are not going to let patients go unattended and suffer.  To think otherwise is ludicrous.  Will I electively schedule a patient in my office?  The answer is no, and the answer is no because I can’t support my practice by doing that.  It’s a simple case of management.  If I can’t make enough money to run the office, then I can’t see the patients.  When I say see the patients, electively in my office.  Essentially the downstream effect of all of this is that if the patients can’t be seen in the physician’s office, then they’re seen in an emergency room setting.  In an emergency room setting, the cost is exponentially more.  If that is the case overall, then the cost of the healthcare system is very, very high.

From the standpoint of Medicaid, Medicaid will fight you tooth and nail on any penny.  The reimbursement is poor already.  By the way, at the end of the year, and it’s now coming up about that time, I will probably get a letter from my state saying: Medicaid funds are now empty.  We will hold all payment for the next 30, 45 days, etc.  How in the world can anyone run a business when they’re paying on credit for two months?  This is the problem.  The translation to the overall healthcare system is that when all these individuals are seen in an emergency care setting, emergency rooms are overrun.  When emergency rooms are overrun, you have to staff your emergency room with people that are probably not as highly trained as you would want because you just need personnel to just take care of the patients.  When that happens, you start relying on medical testing, not on physical exam or history taking because you don’t have the time.

The first thing that happens if you go to the emergency room and your tummy hurts is somebody sends you for a CT scan.  You get a CT scan and it shows some incidental finding that probably has little to do with why you went.  Then you get admitted to the hospital.  Next thing you know, you have $10,000 worth of testing.  The virus that you had is finally cleared and you go home.  That, in a nutshell, is medical care in the U.S.

Mike:  So, we are a tester nation.

Caller Bill:  Absolutely, absolutely.  Ask any of your friends or family members who have gone to an emergency room within the past year.

Mike:  I have.

Caller Bill:  Ask the radiologist that tells you that all these x-ray tests that are performed, they don’t tell you that from a percentage standpoint the testing has probably gone up between 200 and 500 percent over the last five years.  That’s because of the reliance on testing.  Some people will say we have to do that because we need to make sure that somebody doesn’t have this, that or the other so we don’t get sued.  Liability and litigation is part of it, but a lot of it is time.  There are so many people that now use the medical care system, probably that don’t need to.  You have the situation where you’re overrun by numbers.

Mike:  I understand the testing part of it.  You’re right, anyone that’s been to a hospital, especially if you go in there with a child, they want to over test.  You can tell just by the language that’s used and the way the doctor talks about the test, that the doctor is ordering the test not to determine sickness as a matter of course, but in order to avoid any questions that might come up later if he gets hauled into court and sued because he didn’t catch something.  You guys aren’t allowed to make any mistakes either.

Caller Bill:  That is part of it.  There’s also another part.  The hospitals kind of like it.  Where do they make the most money?  They make the most money off testing.  You can always guide this in the situation where it was done in the name of patient care.  It was done to make sure that you are okay.  There are charlatans out there that will bilk the system.  I think the majority of individuals that do this do this out of a sense of need or a sense of being scared.  There are a percentage of people that are trying to make money off the system.  There’s so little money to be made.  You’ve got to be a high volume person that is going to try to sham the system.  Hopefully those people will be kind of fettered out.

Mike:  In the State of Georgia where you are, it’s the end of October, they’re already out of money.  They ain’t got no money?

Caller Bill:  Mike, I have not received my letter yet.  I’m sure I probably will in the next couple weeks.

Mike:  Just to follow Krugman’s thesis along, from now until the first of the year when they’ve got some money, or when the borrowed funds come in – that means the states are running deficits to cover these debts – until the borrowed funds come in that we all now get to pay back, you’re going to allow the walking dead in Georgia, basically?  There are going to be children and those without Medicaid services roaming the countryside in search of care.  Krugman says 35 to 40 million will not be cared for.  Do you buy that?

Caller Bill:  Absolutely.  You can notice them.  They’re the ones wearing sackcloth, eating bread.  That’s crazy speak.  Is he right about can they control costs?  Yes.  How do they control costs?  They absolutely will deny certain aspects of care.

Mike:  They can control costs by not paying for things is what it sounds like to me.

Caller Bill:  Yes.

Mike:  We’re going to control that cost.  How are you going to do it?  We’re just not going to pay you.

Caller Bill:  I’ll tell you, the difference between Medicare and Medicaid, Medicare does not put a number of those restrictions in place.  The Medicare population, and god bless them, some of my favorite patients are Medicare patients, they have very easy access to the physician’s office.  If you’re 78 years old and you’ve got a problem with the headache and you want to go to the doctor’s office, you can just call up and go to the doctor’s office.  When there’s no skin in the game, when they don’t have a lot to pay, there’s no second thought about going.  Medicare costs have exploded because of accessibility.  It’s a social problem because this is now the way that it’s done, and you can’t take it away.  Once you’ve given this, everyone expects this.

End Mike Church Show Transcript