Pediatrician Lisa Swanson doesnt accept Medicaid patients for one simple reason: Reimbursement rates dont cover her costs.
If I accepted even 10% Medicaid, I would have to close my office, says Swanson, a solo practitioner in the Dallas suburb of Mesquite. Pediatricians make very low margins. I am barely in business. It breaks my heart I cant treat Medicaid patients because I took care of them when I was a resident.
Spencer Berthelsen, a physician and chairman of the 300-physician Kelsey-Seybold Medical Group, Houston, says his group limits Medicaid patients to two types: First, if they were existing patients before they became Medicaid-eligible; second, if a Kelsey-Seybold physician on call treats a patient in a hospital emergency department.
The group doesnt accept walk-in Medicaid patients because reimbursement rates are less than 50% of costs, Berthelsen says. Medicaid charges represent about 0.15%, or $500,000, of the groups $340 million in gross annual charges.
The Medicaid population has the real potential of having higher chronic illnesses. It is a very challenging socio-economic group, Berthelsen says.
Despite increases nationally in Medicaid rates from 1998 to 2003, a growing percentage of physicians are declining to accept Medicaid patients or are limiting the number, according to a study released in August by the Center for Studying Health System Change.
Doctors cited low reimbursement, excessive administrative paperwork and bureaucratic hassles as reasons they avoid or restrict Medicaid, the center found.
In the last half of 2004 and first half of 2005, 14.6% of physicians reported receiving no Medicaid revenue, an increase compared with 12.9% during the same periods in 1996 and 1997. Moreover, 21% of physicians reported accepting no new Medicaid patients, up from 19.4% from the same periods in 1996 and 1997.
The few physicians I know who accept Medicaid have huge volumes of patients80 patients per dayand spend five minutes each with them, Swanson says. They dont have time for preventive care or education. You need to spend time with patients, especially children and their parents.
The center also found Medicaid patients are becoming concentrated in large medical groups, hospitals and community health centers. Solo practitioners such as Swanson have the lowest Medicaid participation rates.
I spend 15 to 30 minutes with each patient, says Swanson, who employs two nurse practitioners. I cant afford to do that under Medicaid. Most patients understand (her decision not to accept Medicaid). Pediatricians are of two mind-sets. I am of the business mind-set that you dont take anything below your costs.
However, other physicians harass us greatly because they believe it is our job as doctors to take care of all patients, Swanson says.
Doug Curran, a family medicine physician with Lakeland Medical Associates in Athens, Texas, says the 11-member group also limits its number of Medicaid patients based on available appointment slots, whether theres an emergency and illness status. About 20% of the groups patient mix is on Medicaid.
In 2003, Texas cut Medicaid rates 2.5%. As a result, less than 50% of Texas physicians participate in Medicaid, says Berthelsen, a member of the Texas Medical Associations Council on Legislation. A recent association survey found that 38% of physicians accepted new Medicaid patients in 2006, down from 67% in 2000.
Curran, who also is president of the Texas Academy of Family Physicians, says the clinic loses $20 for every routine, moderate-complexity office visit.
If we do additional ancillary work, that may help stem financial losses, he says. The bottom line is Medicaid is so inadequate that almost nobody can afford to do it.
Of the 30 to 40 patients Curran sees every 12-hour day, he reserves five to seven slots for Medicaid patients. Every physician has a different mix. Once we hit our limits, we dont see (any more) Medicaid patients that day, Curran says.