The problem with NJ Medicaid and why we are 5 years away from single payer healthcare.
By William D. Charschan, author Cheating Mother Nature, what you need to know to beat chronic pain.
This past week, a packet arrived from Aetna regarding their new Medicaid plan. I asked Connie, our office manager to check into the plan, the reimbursement, etc. because historically, Medicaid paid chiropractors $6 per visit, a ridiculous amount that would put any chiropractor out of business. She came back to me and explained that they pay $6 for a chiropractic visit and $23.50 for the initial evaluation, which in a complicated case could take and hour to complete. Apparently, that is the rate primary doctors in NJ are being paid for a visit which would drive them out of business as well. If a doctors office is not financially comfortable, they are not going to take on more business that may replace their profitable business with unprofitable business.
According to an article in the Sunday Star Ledger, NJ has some of the lowest reimbursement rates for Medicaid in the country, even though it is one of the most expensive states to live in and run a practice. You can read more about this in this Star Ledger here
Governor Christie is getting ready to accept millions of dollars for expanding Medicaid from the federal government, however, how are these folks going to find a doctor? Most hospital practices may accept them in their clinics which filled with interns and likely have better reimbursement rates, however, Medicaid, since it clearly underfunds doctors in NJ so horrifically is not going to be accepted by most doctors who have been financially pinched by insurance carriers for years, with some primary practices scraping by every month. The truth is, most primary care doctors do not have the financial leeway to accept charity care since their current finances (courtesy of insurance carriers). Most people are also unaware that the reason most doctors spend so little time and use physician extenders such as RN, Nurse practitioners and physician assistants is that spending more than 10 minutes a patient is unaffordable to most primary care doctors. Most primary doctors also now log their notes into one of the many electronic health records systems which are time consuming and often inefficient, but because of Medicare incentive payments, many of them purchased these systems. When it comes to cost drivers, the 8 minute doctor visit assures more unneeded tests or tests that come back negative as they attempt to be all things to all people and protect themselves legally in 8 minutes. I cannot imagine Medicaid hasn’t worsened that reality. Further exacerbated by the fact most primary care doctors have little comfort with musculoskeletal problems, who symptoms often overlap organic disease, more time is needed for them to adequately do their job and help us keep medical costs under control.
Electronic medical records were originally designed with the intent of having a huge national data base of information that would be at a doctors fingertips. Unfortunately, they really are only of benefit to large group practices such as Summit Medical Group who shares their data between all the specialties in the group or hospitals. While it does add organization to a note taking system, they do not always uncover all the holes in procedures found in many medical practices. Perhaps, future updates will make these systems as usable as your iphone. These systems are important to consider since their usage is time consuming, and with Medicaid reimbursement so low, most doctors would lose their shirt just filling in the documentation.
NJ needs to update their payment schedules for Medicaid to reflect today’s realities; it cost money to deliver care in an expensive state. Everything in NJ costs more including food, rent, employees, taxes, your home and even eating at a restaurant. NJ needs to pay doctors a living wage reimbursement. Then, and only then will doctors want to see Medicaid patients. If the system rewarded doctors for doing evaluations and spending more time, as is seen in Europe in their social systems, doctors would spend more time, order fewer tests and lower the overall cost of care.
It is time for those who administrate Medicaid in NJ to wake up and move Medicaid into the 21st century. With people flooding into Obamacare and its attempt to insure all by increasing Medicaid, we will have a new class of uninsured insured meaning they have insurance but nobody will want to see them under the terms of their contract with the managed care carrier.
Our office is no different and we will not consider Medicaid contracts that are financially unfeasible with a precertification requirement (more paperwork) and a wait for at $6 payment which would financially harm our practice as well as others.
The solution to this mess has and always will be a single payer system. Medicare for all comes to mind, since their administrative expense if approximately 3% while most insurers are having difficulties reducing their overhead to 20% as described in the Obamacare law. Since most doctors already, take Medicare, it would not be a stretch for Medicare for all because it would mean faster claims payment, fees based on the cost of practice (RBRVS relative value scale is farer to those who need to spend the time in most cases) and although most specialists will be deemphasized financially, the overall cost of tests would be lower. Most important of all, there would no longer be a need for Medicaid, with its complexities and fee schedules that vary from state to state, which means we will all be in the same healthcare class. Also, Medicare as stated in Stephen Brills article is able to negotiate better hospital rates than most insurers are able to do, no matter how large the hospital system becomes.
With healthcare costs becoming so unaffordable for a family of four, and Medicare for all likely to give everyone a 25% discount on their healthcare costs immediately, it is a no brainer. I think we are 5 years away from the conclusion we knew all along; Healthcare should be a social system as in most other countries and one administrator to keep it simple and efficient. We need a single payer system now. Is Medicare for all really a bad idea? I think it is time to retire insurance based healthcare in exchange for a system that is efficient, requires fewer employees to administrate and can begin the trend of lowering American Healthcare Costs in the USA.
What do you think? As always, I appreciate your opinions.
Cheating Mother Nature, what you need to know to beat chronic pain is available through Amazon.com and other booksellers