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Study links higher Medicaid payments to accessibility

Dan Gorenstein Jan 22, 2015
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Study links higher Medicaid payments to accessibility

Dan Gorenstein Jan 22, 2015
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Most things in healthcare are complicated. This one isn’t.

When the federal government under Obamacare paid doctors more to treat Medicaid patients, the doctors treated more Medicaid patients, according to a new report in the New England Journal of Medicine by researchers from the University of Pennsylvania’s Leonard Davis Institute and the Urban Institute. It comes just a few weeks after Medicaid rates, which had been boosted temporarily, returned to their lower levels.

You could say this report is an example of doctors just chasing a buck. But, of course, most things in healthcare are complicated.

If doctors want to treat Medicaid patients, they face difficult economic realities.

For example, Dr. Shawn Purifoy is living his dream: running his own family medicine office in his home town of Malvern, Arkansas. Setting a 20 percent quota on Medicaid patients wasn’t part of the plan.

“Those patients aren’t different kinds of people. They are just people who don’t make as much money. They are still in my kids’ class or going to church with me,” he says.

But Purifoy says the math makes it simple. For a standard visit, Medicaid reimburses him $36, Medicare sends him $67 and Blue Cross pays him $88. On top of that, Medicaid patients tend to be sicker, which eats up his time.

“That doesn’t work financially,” he says. “That sounds like a horrible thing to say but the truth is you are going to get paid a certain amount, and it really doesn’t make that much difference how much more time it takes to do the work.”

To take on more Medicaid patients could mean Purifoy cutting salaries, maybe jobs. Obamacare architects understood these economics from the start. That’s why they put in the two year fee bump.

It’s helped Camden, New Jersey primary care doctor Ramon Acosta patch up some holes in his practice. Literally.

“We have been able to do some repairs, like some roofing work,” he said of the extra money from Medicaid. “We have been able to pay some tax arrears.”

If the bump were to come back  highly unlikely  it would buy Acosta five to ten more minutes a visit. That may sound trivial, but it would mean fewer gut wrenching conversations like a recent one with a boy and his mother who had two pressing concerns about her son.

“Unfortunately, I said which one of the two problems would you like me to address primarily,” he says, recalling that he did not have the time to address both concerns.

Acosta’s made a living off these sorts of hard choices for 26 years now. Asked the trick to staying in business, he says long hours – and knowing money is something other doctors make.

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