The Experiment

While we’re on the subject of healthcare, before it slipped my mind again I wanted to mention a thought I’d had. As of this year we’re beginning an intriguing real-life experiment. For years it has been said that if we cut the fees that physicians are paid by this government program or that they will stop accepting patients from the program that has lowered it fees.

Consistent with the PPACA’s schedule, Medicaid fees are now on the chopping block. If neither the Administration nor the Congress blinks and the cuts are allowed to stand and, starting this year and over the next several years, if physicians start refusing to accept Medicaid patients (not if they already decline to accept them—the change is important), it will support the view that has been put forward for so long.

However, if the number of physicians that accept Medicaid patients declines not at all or only marginally, it will provide some support that maybe Medicare reimbursement rates should be reduced as well.

I would not have elected to carry on such an experiment in this way but it wasn’t my call. Whatever its causes the experiment is now in progress.

3 comments… add one
  • PD Shaw Link

    Recall that in Champaign, IL a hospital and healthcare clinic were accused of colluding to not accept additional Medicaid to put pressure on reimbursement. The case was settled.

  • Andy Link

    Since medicine is ultimate piece work, can’t fee cuts simply be made up in volume or the other various ways people can squeeze income out of the piece work model?

  • steve Link

    More than half of docs are now employed by hospitals or similar entities. Most of those won’t drop out of Medicaid. Many have contracts with hospitals that will require they continue to provide care for Medicaid patients. Finally, Medicaid is heavily concentrated in Peds, OB and geriatric care. I can certainly see a number of specialists who occasionally see Medicaid patients dropping out. I can’t predict what those who see the large bulk of Medicaid patients are going to do.

    Andy- Sure, depending upon the specialty. Or you can farm out more of the work to mid-levels and leverage physician time.


Leave a Comment