Ridiculous Study of the Week: Try My Better Hamster Wheel

A study just came out showing that paying more for Medicaid patients doesn’t entice doctors to take any more Medicaid patients. You don’t say?

Boosting Medicaid payment levels did not incentivize primary care physicians (PCPs) to accept more patients with the government-sponsored health insurance, a longitudinal analysis of claims data for over 20,000 physicians revealed.

A few observations to start this off.  I looked at the study briefly and it really doesn’t make sense.  If a doctor is employed and is paid by an RVU system then it doesn’t matter if Medicaid is paying her employer more as she gets remunerated the same.  In other words, the doctor doesn’t care as she just sees the patients in front of her.  So the doctor isn’t the rate limiting step here.  It seems to me that the employers or hospital systems should be the ones scrutinized over this.

Also, there is no mention that Medicaid patients are really hard to care for.  Let’s be honest.  We all know it. I am not saying that every Medicaid patient is difficult in complexity or baggage but on the whole they are a much more difficult population.  I worked in a FQHC for 10 years so I have a lot of experience in this.  So would a private doc open to Medicaid patients if she is “almost” being paid the same as Medicare?  Probably not.

My favorite part of the piece, however, is what I really want to highlight.  Another ivory tower idiot had to tell the world how to fix this problem.  This one from Harvard Medical School:

Allan H. Goroll, MD questioned whether an increase in fee-for-service (FFS) reimbursement is the appropriate way to incentivize Medicaid participation. “This is not to deny that an astronomical increase in evaluation and management valuations might have some result, but certainly not the aforementioned raising of FFS pay from an impossibly low Medicaid level to an undervalued Medicare level,” he wrote. Goroll noted that methods meant to increase volume will have little effect on practices that are already overloaded or caught in the “hamster wheel.”

Yes, the dreaded hamster wheel.  Docs are dying out there trying to finish their day.  The last thing they care about is adding more difficult patients.  Maybe he is onto something.  Maybe he will recommend DPC?  Then it goes on:

The current FFS payment model, he wrote, is derived from recommendations by the “specialty-dominated” American Medical Association’s Resource-Based Relative Value Update Committee, which “has routinely undervalued primary care evaluation and management services for decades, forcing primary care practices to maximize volume to stay in business.”

Exactly, he does get it!

He pointed to other payment models, such as one he helped develop that substitute FFS with a prospective, risk-adjusted comprehensive payment for delivery of comprehensive care. While a base payment covers practice expenses, a bonus payment is tied to specific patient- and cost-related measures.

And my bubble is officially burst.  I always underestimate the egos of these pompous jerks.  He actually is pushing a payment model he developed! And what is his system? It’s “a prospective, risk-adjusted comprehensive payment for delivery of comprehensive care. While a base payment covers practice expenses, a bonus payment is tied to specific patient- and cost-related measures.”  I don’t know what any of that means other than it will 100% fail.  He just let the hamster off one wheel and put it on another.

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119030cookie-checkRidiculous Study of the Week: Try My Better Hamster Wheel