Do Physicians Avoid Taking Medicaid Patients?

Medicare vs. Medicaid – these terms are not the same. Medicare is a federal program for elderly or disabled individuals, while Medicaid is a state and federal program that provides health coverage for individuals with limited income and resources. According to the latest report from the Centers for Medicare and Medicaid Services, Medicaid insures well over 70 million Americans. Back in 2013, in an attempt to make it much simpler for Medicaid patients to receive care, the government increased Medicaid reimbursement fees as a part of the Affordable Care Act. However, when 2014 came to an end, so did the program. This accounted for fees diminishing once again. Today, patients are finding it rather challenging to find physicians who will offer them care and in a sensible amount of time. “There are certain aspects of Medicaid, particularly for low-income populations, where it is really almost superior to private [insurance] coverage, with very low copays and no deductibles. But at the same time, Medicaid beneficiaries are significantly more likely to report having difficulty finding a provider or delaying care because their health care coverage isn’t widely accepted” said Stephen Zuckerman, co-director and senior fellow with the Urban Institute’s Health Policy Center.

According to results from a survey conducted back in 2011, 31% of physicians were unwilling to take on new Medicaid patients, with the rates ranging from state to state. So why were physicians reluctant to accept Medicaid patients? – Low reimbursement rates. Most physicians stated that they felt it was their duty to provide care to all patients, including those on Medicaid and they recognized the moral need to do so. Still, being that Medicaid is the lowest payer, some were reluctant in providing care that would bankrupt their medical practices. Low reimbursement rates were just a small part of the entire story. Wait times for reimbursement and complex paperwork were also parts of the problem. On top of these issues, most physicians were reluctant to take on Medicaid patients with needs that required lengthier office visits and much more attention.
This study is merely a reminder that Medicaid eligibility and coverage does not necessarily mean ample access to medical services. As a healthcare professional, there are certain questions that you should ask yourself in terms of whether you should drop or avoid Medicaid patients.

1. What issues do Medicaid patients create?
One of the greatest concerns that physicians, such as you, face is the fact that treating Medicaid patients results in more fees than it does in reimbursement. Most physicians are not comfortable with the idea of making a decision to stop or avoid seeing a patient based on financial status; however, Medicaid patients can also create administrative obstacles. A study conducted back in 2013 highlighted physicians’ concerns about Medicaid patients with far more complex needs that require lengthier visits than commercially insured patients. David Zetter, founder of Zetter HealthCare, frequently consults with medical practices on such matters. He states that each patient is one of a kind and whether or not they are a part of the Medicaid program, some patients may simply demand more time and attention. Zetter recommends that each physician ask him or herself the below questions:

• Are my Medicaid patients’ causing me to overuse my available resources?
• Are a large portion of my Medicaid patients non-compliant with treatment plans?
• Do my Medicaid patients frequently show up late or miss their appointments?

2. How will I be able to pack my schedule without Medicaid patients?
If you are considering dropping or avoiding taking on Medicaid patients, you need to ask yourself how you will fill up your schedule. You may think that Medicaid patients are causing you issues such as low reimbursement but believe it or not, some tend to make up a large percentage of frequent and loyal patients. So, you need to determine how your decision will affect every aspect of your medical practice. Will you be able to make up for the loss of Medicaid patients? One mistake that physicians make most often is not planning ahead and leaving holes in their schedules. If you are looking to expand your medical practice, ask yourself how you can market yourself to existing and new patients so that you can build on your medical practice.

3. By dropping or avoiding taking on Medicaid patients, am I doing what is morally ethical?
Several physicians struggle with the idea that dropping or avoiding taking on Medicaid patients is ethically wrong. Ask yourself if you are comfortable with the ethical portion of the issue. As a group, most physicians agree that low-income patients have every right to quality care as the rest of the patient population. Yet, on an individual basis, you need to determine whether your actions come with a personal cost. Perhaps taking on more Medicaid patients will likely lead to career suicide or perhaps dismissing them altogether will drive you out of business. Do your ethical concerns outweigh concerns over Medicaid issues such as low reimbursement and complexity of patients’ needs?

4. Can I avoid taking on only Medicaid patients?
You may not be able to stand the idea of refusing treatment to Medicaid patients, but you also may not be able to afford the financial burden of Medicaid billing services. Limiting the number of Medicaid patients within your medical practice can still allow you to provide them with your services, yet at a more manageable level. “Having the right balance of Medicaid and non-Medicaid clients allows practitioners to still be able to earn income and provide quality service” said Dr. Cinéas, psychotherapist. If you wish to restrict the quantity of Medicaid patients that you see, you need to determine the number of patients that you can afford to treat altogether so that your medical practice does not experience unnecessary consequences as a result of your decision. So ask yourself:

• Am I allowed to restrict the number of Medicaid patients that I see?
• Should I speak with a Medicaid consultant before making any decisions?
• Should I speak with my state’s Medicaid program to determine requirements and limitations before making any decisions?
• On average, how much time do I spend with a single patient?
• Am I flexible with my current working hours? What other working hours am I comfortable with?
• How much am I reimbursed for Medicaid patients? Is this enough for my medical practice to maintain profitability and withstand hard times?

5. Can I hand over current and prospective Medicaid patients to other junior physicians or practitioners?
If you wish to avoid dropping current Medicaid patients or avoid refusing treatment to prospective Medicaid patients, consider using other junior physicians or practitioners, such as physician assistants. They can help manage your Medicaid patients and at the same time, you can lower your medical practice’s administrative fees. Of course, handing over Medicaid patients to other junior professionals raises another issue. You need to determine if these junior professionals are thoroughly capable of providing care to your Medicaid patients and if your patients are willing to receive care from them.

If you are a part of any Medicaid plans such as the Medicaid EHR Incentive program, you will be required to proceed treating Medicaid patients for the purpose of obtaining increased reimbursements from the federal government. If you are a family physician, pediatrician or a professional of another related field, you should note that you are likely to receive increased Medicaid reimbursements. Ask yourself if the increased finances greatly impact your medical practice and weigh in on the pros and cons. Lastly, consider that discharging current Medicaid patients could raise issues such as patient abandonment. For this reason, you need to follow your state’s abandonment rules and do what is best for your patients. Failure to do so could result in legal implications. Being a healthcare professional, there are several considerations that you should take into account when assessing whether you wish to discontinue treatment to Medicaid patients. Look over them and then re-assess your participation within the Medicaid program.