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”.

56590cookie-checkMedicaid and the ER