Oregon will start forcing doctors to accept Medicaid

[Gordon, PA-C]

http://www.ksl.com/?nid=151&sid=34711983

 

 

Here's the short story:

 

Proposed bill in Oregon legislature ties public workers/teachers private insurance plans to Medicaid acceptance rate.  In other words, if you don't see %X of your panel as Medicaid, you are barred from treating private insurance patients who are public employees.

 

Meanwhile, Oregon's medicaid contractor made over 300 million in "profit" last year, despite the fact that it is designated as a nonprofit organization.  

 

This is a power grab that should scare all of us.  If doctors are forced to accept Medicaid, then PAs will be forced to accept it as well, and that means a major paycut is coming to both doctors and PAs in the state of Oregon.

 

 

BTW Oregon is one of the states that gives NPs 100% full independence.  How is is possible that there's a PCP shortage in Oregon?  I thought independent NPs were supposed to solve that problem?

 

 

 

[jdenning]

The practice I work for already does accept Medicaid - we're one of the few specialty practices that does.

 

Will be interesting to see what this means to reimbursement

[EMEDPA]

I work in the ER, one of the only places in the state that accepts medicaid....I see this as a good thing to get folks into primary care...

[Gordon, PA-C]

I work in the ER, one of the only places in the state that accepts medicaid....I see this as a good thing to get folks into primary care...

 

???  

 

Why would a PA go into primary care after this Medicaid law goes through?  PAs in primary care already make a lot less in PC than in subspecialties and this law will make that worse.  

 

What if Oregon passed a law that capped all ER physician income at 150k per year?  This law does the same thing.  

 

What is really rich about this law is that the Oregon medicaid contractor made over 300 million in "profit" last year but says they are too broke to pay doctors closer to what private insurance reimburses.  LOL

[jdenning]

Who is the Oregon Medicaid contractor???

 

I have to jump through all kinds of hoops to get medications approved and it doesn't matter whether it's Care Oregon, Medicaid, Providence, whatever. Noneof them want to approve anything without a ridiculous amount of justification. I don't really see this as being any different than what we're already doing

[EMEDPA]

???  

 

Why would a PA go into primary care after this Medicaid law goes through?  PAs in primary care already make a lot less in PC than in subspecialties and this law will make that worse.  

 

What if Oregon passed a law that capped all ER physician income at 150k per year?  This law does the same thing.  

 

What is really rich about this law is that the Oregon medicaid contractor made over 300 million in "profit" last year but says they are too broke to pay doctors closer to what private insurance reimburses.  LOL

loan repayment, lifestyle, no nights/weeekends/holidays/call.

[EMEDPA]

it makes no sense to force folks to pay for insurance which no one accepts...

 

"Alan Yordy, PeaceHealth's president, said: "The system works as long as everyone shares in (serving) their respective portion of each patient type."HB 3300 "asks the state to set some quid-pro-quo" between doctors

[rev ronin]

EMED, do you understand how much of a PAY CUT accepting medicaid is?  Medicaid patients are some of the most complex patients--they rival medicare sometimes--and they can be among the highest utilizers.  So, not only do you get shafted on a per patient basis, you end up having to do more for them for that pittance.  Not to mention EVERY SINGLE THING needs prior authorization.  Until you've tried to care for medicaid patients as a primary care provider, I'd suggest you not so flippantly throw your primary care colleagues under the bus.

 

I work at a no-EMR shop, and the way we can afford to do that, even with medicare's penalties, is by not seeing a single medicaid patient.

[rev ronin]

it makes no sense to force folks to pay for insurance which no one accepts...

So either get rid of the individual mandate, or start making medicaid acceptable.  I'm ambivalent as to which is chosen, but forcing providers to see patients at a loss is not a reasonable option.

[EMEDPA]

requiring each practice to see 5-10% medicaid should not be that big of a deal. right now our ed census is about 60% medicaid because no pcps will see them. talk about a poor use of govt funds; er visits for rx refills, seasonal allergies, chronic pain, etc.

I don't know what a better answer is. I just know we shouldn't be doing primary care in the er.

[EMEDPA]

So either get rid of the individual mandate, or start making medicaid acceptable.  I'm ambivalent as to which is chosen, but forcing providers to see patients at a loss is not a reasonable option.

I know folks who know how to "play the medicad game" and they make bank.

[aquafresh11]

I work full time in primary care and 80% of my patients are medicaid, the rest medicare, with a few commercial insurers thrown in. I make 6 figures working a 32 hour work week. I don't think the sky will fall.

[EMEDPA]

I work full time in primary care and 80% of my patients are medicaid, the rest medicare, with a few commercial insurers thrown in. I make 6 figures working a 32 hour work week. I don't think the sky will fall.

like I said, play the game right and you can do ok financially with medicaid.

[rev ronin]

I know folks who know how to "play the medicad game" and they make bank.

So to me that either says "fraud" or "stealing time from patient care to do pointless paperwork".  Not sure which, but I don't want any part of either of them. 

 

I'd rather work in a cash-only clinic and do no billing or coding at all.

[EMEDPA]

So to me that either says "fraud" or "stealing time from patient care to do pointless paperwork".  Not sure which, but I don't want any part of either of them. 

 

I'd rather work in a cash-only clinic and do no billing or coding at all.

I know folks who work in a clinic that is cash, medicad, or medicare only. they do very well. 3 guys. each works 2 12 hr shifts/week and makes well over 125k each for a 24 hr work week. 3 pa practice. doc never there, just signs charts.

[dmdpac]

Think docs and private practices will be forced into accepting medicaid patients?  Or will they just change their model to a concierge style practice and not take any insurance? 

 

Cash up front can be mighty appealing (if the sudden boom in concierge practices in my area are any indication).

[EMEDPA]

oregon is not the first state to do this. this is a social justice issue. if you transition to a universal healthcare-like system, providers need to take that coverage. they need to make money of course, but the days of the spine surgeons making 5 million dollars/yr for working 3 days/week are coming to an end.....as well they should...

[rev ronin]

oregon is not the first state to do this. this is a social justice issue. if you transition to a universal healthcare-like system, providers need to take that coverage. they need to make money of course, but the days of the spine surgeons making 5 million dollars/yr for working 3 days/week are coming to an end.....as well they should...

But that's not who's going to be affected by this move.  It's primary care, who do not make anywhere near that amount of money.

 

If you want social justice, how about you (the generalized you, of course, not you personally) start with "equal pay for equal work"?  ACA has tried to implement that by destroying any sort of insurance paying more than Medicaid, rather than by trying to make sure that medicaid pays a living wage.

[EMEDPA]

Rev- I don't disagree with you. I think what will eventually happen is true universal health care like in the UK. we are the only developed nation not to have this. under that system we would all work for the govt at an established wage. I've looked at pay and benefit packages in the UK for PAs. a bit less money but MUCH better benefits like free child care when at work, tuition reimbursement for additional degrees, all practice related fees covered, etc. May end up there or in so. africa or canada in a few years.

[cbrsmurf]

I work full time in primary care and 80% of my patients are medicaid, the rest medicare, with a few commercial insurers thrown in. I make 6 figures working a 32 hour work week. I don't think the sky will fall.

 

I'd be interested in seeing how a clinic can be profitable or pay it's staff with a predominantly medicaid population.  Medicaid pays about $15/visit on avg.  Are you seeing >30 pts in an 8 hr shift?

[EMEDPA]

I'd be interested in seeing how a clinic can be profitable or pay it's staff with a predominantly medicaid population.  Medicaid pays about $15/visit on avg.  Are you seeing >30 pts in an 8 hr shift?

they also pay for all the recommended screenings at intervals. stay on top of those.

[Gordon, PA-C]

I work full time in primary care and 80% of my patients are medicaid, the rest medicare, with a few commercial insurers thrown in. I make 6 figures working a 32 hour work week. I don't think the sky will fall.

 

If the state can force you to see Medicaid, they can also force you to see patients without any insurance at all.

 

That's what is coming down the pipeline.

[Gordon, PA-C]

requiring each practice to see 5-10% medicaid should not be that big of a deal. right now our ed census is about 60% medicaid because no pcps will see them. talk about a poor use of govt funds; er visits for rx refills, seasonal allergies, chronic pain, etc.

I don't know what a better answer is. I just know we shouldn't be doing primary care in the er.

 

Meanwhile, the CEO of PeaceHealth which you cited, had 50 million in guaranteed compensation last year, and his hospital network had over 2 BILLION dollars in revenue and over 1.3 billion dollars in net income after expenses.

[EMEDPA]

 

 

That's what is coming down the pipeline.

hope so. I'm in favor of universal health care.

[EMEDPA]

Meanwhile, the CEO of PeaceHealth which you cited, had 50 million in guaranteed compensation last year, and his hospital network had over 2 BILLION dollars in revenue and over 1.3 billion dollars in net income after expenses.

no arguement there.