Just a Start by Pat Conrad MD

Even as Medicaid is busting state budgets sea to shining sea, organized medicine led by the AMA, concerned advocacy groups, and the at least half of elected officials are pushing to expand the program (and California would like to expand it to large chunks of Latin America).

Medicaid paperwork and reporting requirements continue to enlarge, and states remain under pressure to increase eligibility, and reduce payments to physicians and hospitals. Participation is for many doctors, minimally profitable if not a downright money loser.

Should participation in Medicaid be an individual decision for the practitioner, based on what he thinks is best for his bottom line and according to the dictates of her own conscience?

 Not according to New Hampshire legislation HB 693-FN

  • “A health care practitioner may opt out of the provisions required by paragraph I by paying an annual fee of $10,000 to the department.  Facilities may opt out of the requirements of paragraph I by paying an annual fee of $10,000 per full time professional staff equivalent to the department.”
  • ” The commissioner shall conduct an annual audit of health care practitioners and facilities, including outpatient facilities.  Based on the audited data the commissioner shall calculate the ratio of Medicaid and uninsured procedures to other compensated procedures.”

Much as we like to think of private physicians as free, independent citizens, even DPC docs are de facto agents of the state that controls their licensure.  And now one state seeks to audit their docs to make sure they are sufficiently cooperative, on pain of financial penalty.  If they use any of the extorted monies to bonus providers with above-average Medicaid participation, it will have the added benefit (again) of pitting doctors against each other.

I was predicting this 15 years ago, and I’m only surprised that it has taken this long.  Whether or not the Granite State passes this, expect similar bills to pop up around the nation, especially in states with looser Medicaid eligibility requirements (and not coincidentally, lower payments to doctors).  Where such bills pass, more state auditors will be bothering physicians, some of whom will simply play ball.  Others will be more creative.  It might be easier to assign managed care Medicaid patients to “exclusive” hours, say 2-5 pm on Thursday afternoons.  That will work for a while, until the complaints finally catch up with the malcontents. 

In the shorter run, this will be another way to force doctors to work more, for less pay, in the name of some nebulous “fairness,” defined by the sort of voters for whom Medicare-For-All makes sense.  It will drive more physicians into retirement, and be a sort of jobs program for up and coming LELT’s.

 In the long run, this too will help set another girder for fully nationalized care, and all the coercion and apathy that is to follow.

Get our awesome newsletter by signing up here. We don’t give your email out and we don’t spam you.

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] 

  6 comments for “Just a Start by Pat Conrad MD

  1. TR
    February 10, 2019 at 6:43 pm

    I suggest changing the state of New Hampshire’s motto to “Live Enslaved, Then Die.” I have a license there, but now I may well not renew.

  2. Janis Chester
    February 10, 2019 at 1:42 pm

    This reminds me of dhimmitude status imposed by Muslims on infidels. You have 3 choices: convert, die or accept dhimmitude status and pay a tax called the jizya.

  3. James Tinsley
    February 9, 2019 at 3:45 pm

    I will move before I pay a $10,000 fine to practice medine.

  4. PW
    February 9, 2019 at 9:00 am

    There is no way I can encourage any young person to go into medicine these days.

  5. Frank Lawler
    February 9, 2019 at 8:49 am

    This is what happens when “Health Care is a right.”

  6. Thomas David Guastavino
    February 9, 2019 at 7:00 am

    I am reminded of the seen from “Dr Zhivago” where after the communist revolution. Yuri is told by his brother what hospital he is to be “assigned” to. We are getting closer to that every day.

Comments are closed.