Wrestling With The Limitations Of Medicaid Programs

Medicaid programs have become increasingly difficult to participate in as a podiatric physician in almost every state. The same is true here in Indiana. There are very few podiatrists providing care for Medicaid patients in Indiana. I have debated this problem for my own practice over the past several years. I had made a decision to stop seeing Medicaid patients but I have had to reconsider my decision regarding this. This led me to wonder what others feel about their state programs and if they participate in them.

There were several reasons that I had decided to stop participating in Medicaid in Indiana. First, the reimbursement is, at worst, insulting and I like everyone else in practice am running a business. From a pure business standpoint, this program makes absolutely no sense.

In my 20 years of practice, I have also found that these patients in general tend to be some of the most demanding of all my patients with the most unrealistic expectations. It has also been demonstrated that Medicaid patients are more like to file malpractice claims than non-Medicaid patients. The risk versus reward scenario for these patients is unacceptable. Finally, the last straw for me was being audited by Medicaid, which seemed utterly ridiculous to me.

Alternately, there are several factors that have led me to reconsider my position on Medicaid patients. The primary factor was the pushback I was receiving from my primary care referring physicians. They were very upset about this and I had to give ground by agreeing to see their Medicaid patients. Accordingly, I made the decision to only see Medicaid patients when they are referred by a physician’s office. I also essentially stopped doing any surgery on Medicaid patients unless there was an emergency situation. Other reasons to reconsider include potential referral by Medicaid patients to other prospective patients and the moral dilemma of not providing care for these patients.

In trying to arrive at solutions that I cam comfortable with, I no longer perform elective surgery on Medicaid patients and, if necessary, provide free care for Medicaid patients at one to two free health clinics that I volunteer at each month. These solutions have been working for me but they may not be suitable for others. There are very few podiatrists that will even see Medicaid patients in central Indiana so I can live with the choices I have made in this regard. I make exceptions of course but I try to stick with these general rules.

Medicaid programs are becoming more and more difficult to participate in and there is no simple solution to this problem. I have found solutions that work for me. I am interested in hearing what others have to say about this problem. I would like to hear your comments and experiences.



David Gurvissays: February 18, 2011 at 1:15 pm

I see these patients only upon referral from a PCP who also sends me the "good" patients. I have had the situation of a PCP who normally refers to a different podiatrist who then no longer takes Medicaid. That PCP then starts sending all the Medicaid patients to my office which I will not tolerate. I simply refuse. They can use me for all their referrals or none. I will also see a Medicaid patient who is a family member of an existing patient. Beyond that, no. It makes moral sense to see them but finally and emotionally, it is a drain.

I want to take care of these patients, but I also have a family and i would rather work for nothing than be insulted by what they consider payment. It's just how it is.

David Gurvis, DPM

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Jon Fallis, DPMsays: March 17, 2011 at 10:36 am

I too am struggling over the decision to see Medicaid patients or not. Currently, I will only see referrals and have stopped elective surgery. Aside from the poor reimbursement and the struggle to actually get a claim processed correctly, my chief concern is that Medicaid forces us to practice below the standard of care. I have to explain to patients my normal treatment protocol for their condition, that Medicaid will not pay for that service and explain the other options available. I frequently let my state and federal legislators know of the situation for what it is worth.

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