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jmj11

I'm Sorry To Say This . . . But

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I'm a very compassionate guy. I mean, I love to give away care for free, especially in the developing world. However, I made a business decision two months ago to stop accepting all medicaid related insurances.

 

Since then, our revenues have had a significant increase, which I sort of expected.  However, on top of that, we have had a huge plummet in; a) argumentative and angry patients, 2) no shows, 3) late comers, 4) drug seeking behavior, 5) phone calls and etc. Our lives are 80% better.

 

I hate to turn away the poor who need help. I'm sure there is a lot of good people in the mix of those medicaid people who are not. But I am rather shocked to see what difference this has made.

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You deserve the improved QOL. I get the guilt, but this is you're life first and fore most. You've put in way too much effort and time for anyone to think otherwise of this decision. Enjoy :)

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I used to work one day at a community clinic where all the pts were either MediCal (Medicaid in cali) or indigent and 99 percent are argumentative, conniving, Norco seeking, latecomers, and no showers. We practically threw out the schedule every day and just did first come first serve. I dropped my contract in Nov because the administration acted like the pts. I'm all for altruism but I ain't trying to pull any one else's little red wagon. My days my practice where we do not accept MediCal is infinitely better though we get the occasional cut up.

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The year I spent in Africa as a short term missionary I was able to go to a mission hospital and watch a surgery.  I also went to an outreach clinic where the tribes people were getting glasses and vision care.  I had  peanut soup in the hut of the tribal chief (mud floor, thatched roof) and heard a story (thru interpreters) of the African's view of life.  They were so humble and appreciative of the services given and so thankful and joyous.  It was a life changing experience.  The people worked and farmed and kept sheep.  They were truly poor but thankful.  They did not expect a free handout and worked hard for their sustenance.  

 

So keep that in mind.  Our state of the American mind is to get whatever you can for free and when you get it to complain.  It is a sad state of affairs we have dug this county into and those that suffer the most are the ones who do not reach their full potential because they are blinded to their own dependence on government. 

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The year I spent in Africa as a short term missionary I was able to go to a mission hospital and watch a surgery.  I also went to an outreach clinic where the tribes people were getting glasses and vision care.  I had  peanut soup in the hut of the tribal chief (mud floor, thatched roof) and heard a story (thru interpreters) of the African's view of life.  They were so humble and appreciative of the services given and so thankful and joyous.  It was a life changing experience.  The people worked and farmed and kept sheep.  They were truly poor but thankful.  They did not expect a free handout and worked hard for their sustenance.  

 

So keep that in mind.  Our state of the American mind is to get whatever you can for free and when you get it to complain.  It is a sad state of affairs we have dug this county into and those that suffer the most are the ones who do not reach their full potential because they are blinded to their own dependence on government. 

As an African who also lived in America for a long time, I can say that this is absolutely true. Healthcare is viewed as a gift, even in the cities.

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That is the mindset in Haiti as well. folks walk 11 miles for a 5 min appointment, receive 30 Tylenol, thank you, and say they will pray for you and your family.

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good call

 

 

I never accepted Medicaid primary for exactly that reason, I get medicaid secondary (behind medicare only) as this somewhat triages the really difficult patients.

 

It is however almost 100% true that my problem patients do have medicaid as the secondary.........

 

 

 

 

On this same note, I just listened to a friend vent for over 30 min about his step daughter with two kids who has been living with them for the past year (not paying any rent or helping out on bills) complain about everything in the house, not help out, and in general be ungrateful.  Thankfully she is moving out(with her kids) to subsidized house in a high rent district where she has to pay a whooping $160/month due to gov't benefits.  There is nothing wrong with this lady, she is completely able to work, but instead she **tches and gripes about everything, doesn't help out in any way, and in general is living off the system.   She also does complain about the crappy health care she gets.....  Well no thank you - you may go to the not for profit clinic for your health care.....  Only ones I feel bad for are the true mentally ill who are lumped in with the lazy.... they really do need out help, but the rest of them need to get a job......

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Only ones I feel bad for are the true mentally ill who are lumped in with the lazy.... they really do need out help, but the rest of them need to get a job......

and the truly disabled who can't get the care they need with their crappy coverage......

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That is the mindset in Haiti as well. folks walk 11 miles for a 5 min appointment, receive 30 Tylenol, thank you, and say they will pray for you and your family.

Same in Honduras

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For a brief period, some years ago, i was on MediCal in CA. It was a fight to get it and and even bigger fight to keep it. Im glad it was available to me until i could do better. However, I was not sad to move on. The case workers who administered the program were difficult at best. As a patient fighting for benefits, when you get used hammering, everything looks like a nail.

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My family was on WI Badgercare (medicaid) when I was in PA school.  We paid the highest premium for it as we just barely qualified for it, I think it was $150 a month.  It was a life saver for the 2 years and I appreciated it.  My husband worked full time (self-employed).  I was very happy to get off of it, too.  

 

My son-in law has a genetic condition that has made him wheelchair dependent and he cannot work.  He gets state disability insurance/health insurance and they have to fight to keep it.  My daughter is in grad school and buys her own health insurance.  She works as a caregiver part time for her husband, but they pay her about 12 hours a week as that is all he qualifies for since she is married to him.   If she didn't do any caregiving and had someone come in they could get a full-time worker through the state for 32 hours a week, but then she would lose her job as his caregiver, thus lose income.  

 

Does not make any sense at all. 

 

They are an amazing couple, I must say.  Never complain and working toward  a good life.  He is able to use a computer and is "writing" a book through Dragon dictation.  That is his work.  He even got an Associates Degree in Architectural Engineering and never gives up. 

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The feds or state needs to build in accountability into these programs because the bad behavior of the 50% hurts the ability of the good 50% of patients on medicaid to get care. First, no-show fees should be allowed.  There is no incentive for the Medicaid (bad patients) to keep their appointments like there is for others. It was no-shows alone that killed us. One day we had four Medicaid patients schedule for 90 minutes new patient consults and all four no-showed despite reminder calls. A practice can't exist like that. I do realize many good people end up on these programs. I've kept all of our old Medicaid patients, but I'm will not hesitate to dismiss those who routinely no-show or are argumentative.  Many of the ones I kept are good people who, like others mentioned above, got caught in bad circumstances.

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Mike, that's fascinating. Thanks for sharing the observation.

 

In terms of no-shows, it has often occurred to me that folks with chaotic lives and mental/emotional difficulties are both more likely to have Medicaid and far less likely to be able to make and keep a medical appointment. Fitting into the medical system's time management guidelines and following our rules requires a certain level of organization. It may be more practical for some to sit all day in the ED or walk-in clinic than to structure future time for an appointment.

 

The other things you mention, though, I would not have expected to such a degree.

 

And I am 100% in favor of your decision. The need is infinite. You've done your part. It is more than OK to take care of yourself and your practice this way.

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Good to hear everyones viewpoints. A challenge - but you have a good heart about it. I have seen both sides as a patient with medicaid (having a young family and losing my job) and now as a primary care provider. I haven't dealt with it from ownership of a practice which is another unique situation.

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This whole conversation saddens me...not because I am upset or disagree with anyone, but because this is an example of a continuum of violence, anger and impatience that passes from institutions to people and from one person to another.

I'll be starting PA school in August, and am very excited.  On the other hand, I am prepared to be challenged by a medical system that does not work for so many citizens in this country. 

 

I have been a volunteer at a free clinic for the past eight years, and have therefore been insulated from the financial stresses of managing a practice or dealing with MediCal.  I have, however, seen my share of angry, upset, hopeless, grateful, ungrateful, stoic, complicated, and inspiring patients.  But I haven't had a good reason to judge any of them for feeling the way they are feeling. 

 

I am not sure we will get anywhere by trying to blame patients for their suffering.  A wise person once said "why are we trying to make better patients? Why not try, instead, to make things better for our patients?"  Why are we blaming our patients while maintaining invisible the very factors that lead to their disease and suffering in the first place?  I could name so many...poverty, lack of sleep from working two jobs, domestic violence, institutional racism and discrimination, symbolic violence, this list could go on...

 

I have a feeling I may get some backlash from this post.  I am admittedly naive to the "reality" of working within a reimbursement system that apparently never intended to make healthcare truly accessible to all Americans.  But I do have plenty of experience working with the "population" in question (i.e. the poor) and feel that we would all do better to recognize rather than minimize the social determinents of disease.  And it's no wonder to me that symptoms of this social disease include anger, frustration, violence, substance abuse...

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This whole conversation saddens me...not because I am upset or disagree with anyone, but because this is an example of a continuum of violence, anger and impatience that passes from institutions to people and from one person to another.

I'll be starting PA school in August, and am very excited.  On the other hand, I am prepared to be challenged by a medical system that does not work for so many citizens in this country. 

 

I have been a volunteer at a free clinic for the past eight years, and have therefore been insulated from the financial stresses of managing a practice or dealing with MediCal.  I have, however, seen my share of angry, upset, hopeless, grateful, ungrateful, stoic, complicated, and inspiring patients.  But I haven't had a good reason to judge any of them for feeling the way they are feeling. 

 

I am not sure we will get anywhere by trying to blame patients for their suffering.  A wise person once said "why are we trying to make better patients? Why not try, instead, to make things better for our patients?"  Why are we blaming our patients while maintaining invisible the very factors that lead to their disease and suffering in the first place?  I could name so many...poverty, lack of sleep from working two jobs, domestic violence, institutional racism and discrimination, symbolic violence, this list could go on...

 

I have a feeling I may get some backlash from this post.  I am admittedly naive to the "reality" of working within a reimbursement system that apparently never intended to make healthcare truly accessible to all Americans.  But I do have plenty of experience working with the "population" in question (i.e. the poor) and feel that we would all do better to recognize rather than minimize the social determinents of disease.  And it's no wonder to me that symptoms of this social disease include anger, frustration, violence, substance abuse...

Your experience is yours and creates your personal truth. Since I retired from the military in 95 I have worked in rural health in underserved areas and currently work in a federally qualified Community Health Care Center (clinic). I have finally reached the breaking point and am looking for something a little easier for my last 10 years before retirement. 

Let me qualify my comments by saying I hate generalizations even though I am about to make some. I work in one of the 100 poorest counties in the US. My patients are generally uneducated and ignorant. I have a no-show rate of 20%. Non compliance with meds is about 50%. Inability to afford meds and tests and referrals is high. Number of people who could improve their health or completely ameliorate their problems with lifestyle mods is 100%. Obesity and smoking are near 100%. Percentage of people who are willing to improve their lifestyle to improve their health is near 0%. Eye rolls, getting up and leaving the exam room, arm crossing and pffth noises are a daily event when trying to teach people how to eat well, exercise, quit smoking. "Just give me a pill" "I'm not going to do that"... every day.

As a society we destroy our health through bad lifestyle choices. This is far more prevalent among the poor and uneducated. Entitlement among the poor and uneducated is rampant. Medicaid patients routinely tell me "what do you care? It's free" when I explain why I won't order an unneeded test or medicine. The most recent was when the mother of a Medicaid patient poured 20 of her kids ventolin nebs into a room humidifier in her room "so I could breathe better."  I could go on and on.

I bend over backwards to help people who have been run over by life...who need a helping hand ...who are working hard and just not making it. I have developed disdain for the lazy and entitled. I need to let someone else do this.

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If you give people something for free and tell them they deserve it, they a) often place no value on it and b) feel entitled. Additionally, with zero understanding of medicine or our healthcare system, many patients have unrealistic expectations and don't understand that they need to participate in maintaining or improving their health. As a result, they disrespect the system and providers.

 

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I have several patients that have been in this country for less than 2 months and have Medicaid.  One from Cuba and several from the middle east  Others have lived here for a long period of time and send for their parents to come here and get on Medicaid.  How does this happen.  I get very annoyed by this!!

 

We probably all know someone who deserves to be on and is denied multiply times.

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 I am not a braggart - I am all for altruism myself. I used to work for the HHSC and give indigents food stamps and Medicaid. Almost immediately as soon as it was in their hands they would sell them for either illegal drugs, alcohol, and/or prostitution. I recall a man and his family giving me his Green Card as they needed food stamps. I explained to them (in my broken Spanish) that I couldn't give it to them because the card was fraudulent (there is a way to tell immediately without going into much detail). He told me (in his broken English) that he and his family had been using the card for years and there must be a mistake and I must be prejudice because he was Hispanic. The next thing I knew he threaten me with a knife! In my calm demeanor I asked if he would release me and I would ask my supervisor if there was something in the policy I didn't know about (although I knew better). Suprisingly, he did release me and my sup explained it was in the policy - and NOT mehttps://www.dads.state.tx.us/handbooks/texasworks/A/300/300.htm The office escorted him and his family out the door. Needless to say, the office had NO metal detectors and NO security (that is the government for you and another story). For all I knew he could have came back and done it again. I lost 6 lbs in 6 mo and I wasn't even trying to. Talking about stress! 

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Some of the observatuons about the the the happy, humble, grateful poor of the 3rd world here are just naive. This affect is mostly mask and survival mechanism which is learned and passed down in people who are completely destitute and powerless to change their lives (they're actually angry too) and have been for generations. Their passivity comes from having zero expectations for the future. There is no precident for acting uppity or entitled ;getting has always entailed beseeching (as well as often paying a bribe).

 

Nor has not "getting things from the government" turned these people into successful entrepreneurs or the like. As in all third world countries, there is no infrastructure spending, education spending or social safety net. Any taxes that are wrung out of the people disappear down the rathole. The American poor at least have some kind of agency or at least believe that they do and if they qualify for a service they get it based on that, regardless of how they act. I'm not justifying those who act rude, but this probably explains the differing impressions.

 

"As a society we destroy our health through bad lifestyle choices."

 

Thing about how much money and effort we expend as a society trying to convince people to do just that. It shouldn't really be a surprise that not everyone has the self-discipline to avoid temptation. People are subjected to a continuous bombardment of conditioning to eat crap, drink beer, smoke (some progress) and get rich quick with lotto as soon as they become aware of their surroundings. People get phd's in psychology and do experiments on monkeys to come up with more effective ways of breaking through people's defenses. And as Americans we are conditioned to believe that our lives should revolve around buying things. So what do you buy with $5?

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Imagine a future that may not be far away. A future where healthcare is "free" for everyone because it is both mandated and "paid for" by government. Essentially, medicare or medicaid for all. Does anyone believe patients will be better off? Or that they will have expanded access? Or that they will participate in helping to improve their own health? I read a few days ago that Britain is ranked high in worldwide healthcare systems but is criticized for poor accessibility and cancer survival rates. I also noted that Astrazeneca's Lynparza (olaparib) is not paid for by NICE despite the fact that it has been shown to be very effective in treating women with advanced ovarian cancer who have DNA repair mutations, such as BRCA 1 or 2, and who have failed chemotherapy. This is a last resort treatment for these women but NICE calculates that it is too expensive. (And the Brits pay less for Lynparza than Americans.) This is just one example but I know of many others. Do we really want a system where patients have access to unlimited care but miss appointments, don't take their meds and demand attention for self inflicted illnesses, while some very deserving patients are denied effective and needed care because of cost? Many young people think of health care as abortion, birth control, substance abuse management, pain control, counseling, mending broken bones and dispensing antibiotics. As we get older we discover the more expensive chronic afflictions that affect every aspect of our lives and, often, we come to depend on the advances of modern medicine for quality of life, for continued productivity, or for our very existence. The future may consist of government approved treatment pathways for every illness or affliction, and those pathways may end abruptly when treatment options become expensive, without patients even being informed of options. For those who support single payer options, or even options which the government controls, the future may become very dim and fade to black.

 

Sent from my SM-G900V using Tapatalk

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Imagine a future that may not be far away. A future where healthcare is "free" for everyone because it is both mandated and "paid for" by government. Essentially, medicare or medicaid for all. Does anyone believe patients will be better off? Or that they will have expanded access? Or that they will participate in helping to improve their own health? I read a few days ago that Britain is ranked high in worldwide healthcare systems but is criticized for poor accessibility and cancer survival rates. I also noted that Astrazeneca's Lynparza (olaparib) is not paid for by NICE despite the fact that it has been shown to be very effective in treating women with advanced ovarian cancer who have DNA repair mutations, such as BRCA 1 or 2, and who have failed chemotherapy. This is a last resort treatment for these women but NICE calculates that it is too expensive. (And the Brits pay less for Lynparza than Americans.) This is just one example but I know of many others. Do we really want a system where patients have access to unlimited care but miss appointments, don't take their meds and demand attention for self inflicted illnesses, while some very deserving patients are denied effective and needed care because of cost? Many young people think of health care as abortion, birth control, substance abuse management, pain control, counseling, mending broken bones and dispensing antibiotics. As we get older we discover the more expensive chronic afflictions that affect every aspect of our lives and, often, we come to depend on the advances of modern medicine for quality of life, for continued productivity, or for our very existence. The future may consist of government approved treatment pathways for every illness or affliction, and those pathways may end abruptly when treatment options become expensive, without patients even being informed of options. For those who support single payer options, or even options which the government controls, the future may become very dim and fade to black.

 

Sent from my SM-G900V using Tapatalk

I recently traveled to Croatia and Bosnia and discussed their "universal healthcare" with a couple of the drivers we used. Unanimously they despised the government provided care because a) it wasn't really free. Their employers were required to pay x amount to the gov for each employee to receive HC coverage. The workers felt like this money could have been provided as salary instead. B) The care came with ridiculous waiting times e.g. 6 month wait for abd CT to rule out appy. and C) the government was so corrupt that they felt that the money wasn't being put back into HC facilities. Furthermore, Physicians there were paid a standard rate whether they saw 1 or 20 patients a day which led to ridiculous wait times for appointments. It's interesting to me that these systems have failed so miserably that the rich pay cash to private MDs and skip out on gov subsidized HC all together and there are private insurance firms popping up underground. 

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