Medicaid and the ER


Most illnesses do NOT need to be seen in the ER.  Having a good family doctor, who knows you and can see you, would prevent a lot of needless expenses.  Making the patient and family accountable for some of this would also help a lot.  Unfortunately, this does not always happen.  As an example, with Medicaid where the family pays nothing, much of this accountability goes out the window.

Here is what the media is reporting.

  • “Children covered by Medicaid visit the emergency room for medical care far more often than uninsured or privately insured youngsters.”  

Really?  That comes as a big surprise. Not. Here’s more:

  • “And kids with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention.”

I bet many doctors are NOT surprised at this.  Here is some more from the article:

  • “In many parts of the country, patients cannot find doctors who will take Medicaid patients,” he said. With the expansion of Medicaid under the Affordable Care Act, emergency room visits might actually increase, he added.

A couple of things here.  I agree that many doctors are not taking Medicaid.  They are the toughest of patients and the government pays pennies on the dollar.  I have always heard that if a private primary care doctor takes more than 12% Medicaid then he will lose money in the practice overall and he will go bankrupt.  Sorry, cannot find that reference but it intuitively makes sense.  Those 12% will probably take up 40% of your visits and you will lose money because you get paid so little from the gov’t and subsequently can’t fit in real paying patients.

Second, it is not always about not having a doctor.  I saw Medicaid patients for my first fifteen years in practice.  Almost half of my panel was Medicaid, in fact. I was employed and worked for a Federally Qualified Health Center so there was a benefit to seeing them.  I cannot tell you how many times these patients went to the ER during regular office hours for minor issues even though I had openings!  I saw the ER reports and would try to backtrack and see why they were turned away from my office.  They weren’t.  They didn’t even call.  When I asked them about it later they would say that it was just easier to go to the ER because it was closer and it didn’t cost them anything.  Hmmmmm. Here is what the study shows that proves my point:

  • “Just two out of 10 uninsured children went on a doctor’s recommendation, according to the report.”

Trust me, expanding Medicaid only would make this situation worse.  People have to have some skin in the game even if they have Medicaid or else they follow the American credo of “I want what I what, when I want it, and I want it for free”.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Medicaid and the ER

  1. July 30, 2014 at 9:13 pm

    I disagree with a little bit of the sentiment – if something is given with disrespect, it will become disrespected. We have Dumbed Down medicine with our Dumbed Down culture to believe that all there is to medicine is whether to “Sent ‘Em To The Emergency Room!” That is why I think medical care costs will TRIPLE under Obamacare – all that will be left of primary care is an obligate step for someone in a white coat to say “Umm-send ’em to the emergency room.”
    Men of dignity, men of honor, real men don’t fit into the assertion – “Give a man free food and he’ll figure out a way to steal more than he can eat, ’cause he doesn’t have to pay.” The problem is we reward men for being louses (lice?) and punish them for being men. (Gender parity omitted for brevity only.)
    If everyone in society is sh*t, they behave like sh*t. In a decent society, there are very few who behave like sh*t – so few that they can be handled by isolation or incarceration or education. But now, sh*t is the word.

  2. Peter Winston
    July 30, 2014 at 11:39 am

    Everything is true, but doesn’t mean is shouldn’t be done. However, my focus is on the last sentence. SKIN IN THE GAME is all that matters. It doesn’t need to be much. Medicaid patients respond to monetary incentives (or disincentives). A moderate copay to go to the ER is all that is needed if they know that it is then cheaper to go to a doctor’s office. Now if the regulators that set these rules would only see the light.

  3. Pat
    July 27, 2014 at 10:41 am

    A lyric from one of my favorite bands, The Rainmakers, from their song “Government Cheese”: “Give a man free food and he’ll figure out a way to steal more than he can eat, ’cause he doesn’t have to pay…give a woman free kids and you’ll find ’em in the dirt, learning how to carry on the family line of work”
    …the songwriter downplayed that song in later years as harsh, but it resonated because it was true then as now. When a good or service becomes a right, beneficiaries will over-consume, leading to cost overruns, then shortages, then rationing – there is no disincentive, no economic skin in the game, just wants that will always outstrip someone else’s ability to satisfy them.

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