There is a doctor practice in town that has been finding reasons to get rid of patients they don't want. It all came out in the paper. They don't like patients who are too complicated or timeconsuming, they get rid of anyone who changes insurance, they don't take Medicaid. I had one patient who told me that she was fired from this practice, the reason given was that she was rude to the receptionist. This patient was a very nice woman, I was really surprised about that. Other reasons being given is when patients live too far away, yet we live far away and I was encouraged to sign our family up there.
Meanwhile, the practice is recruiting new patients. In fact, I had approached the head of the practice about switching our family there because I was dissatisfied with the clinic where we were going which was bought by the hospital where I work and I didn't like the way they were doing things.
Ironically, this practice in known as an all Christian practice, that was one thing I liked about them since they pray for their patients. We haven't gone there yet, but we were accepted as patients. Now I'm worried that if any one of us ends up with chronic problems, we'll get fired as well.
I was told that for every Medicare dollar spent on pt care, a particular clinic gets 30 cents of that dollar. If a practice has a large amt. of Medicare pts. who are consistantly no-shows for appts. or non-compliant and it can be documented, then something needs to be done to protect those who ARE compliant and show up, etc.
I would like to say that where I work (which is a low-income area) about 40-45% of our total pts are Medicaid. Of the sick visits I see every day, about 70-80% are MCD, and of those about 40% actually need to be in the office (and we do offer a nurse line, where all our pts can call and be helped over the phone before coming in- mostly insurance pts call the nurse line and this is fine. If your child isn't sick enough to need meds, I don't want to waste the time or money of a visit).
We have some wonderful, RESPONSIBLE MCD pts, and I love them. they come on time to the appointments and they are complient with treatments. They are good parents. And then we have the Others. Those who will make an appointment- blocking 15 minutes of my work time and then not show, they don't call to cancel (during which we could re-book the time), they just don't show up (and then they call after hours to the answering service, and I get paiged and they want the abx called in NOW becasue their child is REALLY sick).
I personally (not counting the other providers) on average have about 2-4 no shows in each 4 hours that I work. Each of these no shows cost the practice (I am paid hourly) anywhere from 80-150 or even more dollars. It adds up very quickly. Yes, we can account for the no-shows by double-booking-placing two visits in a slot, but if both show up, that adds for longer wait times for the pts- and no one likes that- and then I get behind on my schedule, etc.
Even though I am paid hourly, so it doesn't matter to my paycheck how many pts I see or charges I set, I feel a responsibility to make a profit for the group. We have ancillary staff, rent, equipment- all of which costs money and all of which I use every day. I also believe that if I see a pt with an ear infection and treat it accordingly, I should be paid by MCD 100% of what a doctor gets, not 80% because I have NP after my name. No difference in treatments/assessments= no difference in pay.
So, I feel that I do have a right to refuse a pt care, if it is the type who is not respectful of my time or is not complient(as I try to be of theirs. I will bust my hump to stay on schedule for my pts). The pt is free to fire me if they don't like the appointment time, my behaviors, etc. It works both ways. What really stinks is that the kids are the ones who need the help, but it is the parents who are the ---holes.
Insurance pts do this too, but with lesser frequency- and believe me, we treat those who do just like our MCD.
Thank you for the article. I have "punted" too, and I definately have been in similar situations. The shopping pt is one of the worst. They suck your time for awhile and then they move on. Big investment in them in the beginning without the payoff of a continued health care relationship.
I've posted this elsewhere on this board, but here I go again.
In my old city of 300,000 population, very few dentists took Medicaid and the newspaper decided to investigate as to why. The dentists were more than happy to use their names and pictures when telling them why.
They said that in addition to reimbursement being below cost, their experience is that these patients do not show up for their appointments, nor do they call to cancel; they are often abusive to the staff; and every dentist they interviewed said that they had multiple incidents where their children were so out of control, the police had to be called. This did not happen with any other class of patients.
One dentist said that they may not have the means to take the kids to the dentist, but they always have money for sculptured nails and hair weaves, and have no problem going to an amusement park that is 3 hours away and costs $30 a person to get into.
My dentist does a lot of pro bono work, and she said this is 100% correct and does a huge disservice to the honest, hard-working people who have fallen on hard times, or people like my grandmother who was on Medicaid for the last few years of her life.
If doctors wont take new patients or discharge them, then tell them to go see an NP. There are plenty of NPs around in every corner of the country to treat patients. I seriously doubt that anybody has to drive more than 30 miles or so to get to an NP clinic.
As for whether docs should be allowed to D/C patients, then absolutely YES they should be able to. I mean come on what are we talking about? FORCING doctors to treat patients in a non-emergency setting? Thats totally unfair. I dont see dentists being required to treat everybody that comes thru their door. I dont see lawyers being forced to take every single person who walks thru their door as a client. Thats communist/socialism BS and its totally antithetical to a free and fair society.
NOBODY should be forced to take "customers" they dont want (exceptions are race and gender). Every doctor should have the right to decide which patients they want, and which ones they dont want (exception = ER).
Somebody mentioned a law that would require doctors to take X% of their patient panel as Medicaid/Medicare. Thats absolutely insane, and the entire system would collapse if that kind of communist crap passed into law.
Thankyou for your post.What I have read in the preceding posts about Medicare/ Medicaid patients not being accepted by many doctors and the generalizations about those who recieve Medicaid/Medicare has truly made me sick at heart.
I will be on Medicare as soon as I am approved for SSDI.
Despite being disabled, I believe I still have worth as human being, I worked for almost 30 years as a nurse, put my kids through private school and college as a divorced mother of four children. I have been a good patient , I do not seek care for frivolous reasons. If I just up and died so as to not be a burden on the oh so hard working deserving able bodied folks, my kids and grandkids would miss me, so I guess I will stay alive and mooch off of the government dole, like the rest of the bloodsucking leeches of society.
We truly need COMPREHENSIVE health care reform, and soon.
Ingelein -Are you SURE about the medicare? I was recently approved for SSDI, but I won't be able to get medicare for two years.
I was approved super fast - in about three months, which surprised even my doctor. I could have done all the applying over the phone, but I actually went to the appointments in person, so that they could see for themselves how badly I tremor.
In the meantime, almost every bit of money I get goes to pay the $645 premium for the lousy insurance I had to get once my COBRA ran out, plus my higher copay for my drugs.
I'm not sure what to think about your statement about 'mooching off of the government dole'. Do you REALLY think people feel that way about you?
Sorry, chickie, but you've paid your way and done your best. That's what assistence programs SHOULD be for and NOT for multiple young people having children so that they CAN get benefits. If there weren't so many freaking social programs for the able-bodied, maybe we COULD concentrate on and do better things for those who really need it.
Ingelein -Are you SURE about the medicare? I was recently approved for SSDI, but I won't be able to get medicare for two years.
I was approved super fast - in about three months, which surprised even my doctor. I could have done all the applying over the phone, but I actually went to the appointments in person, so that they could see for themselves how badly I tremor.
In the meantime, almost every bit of money I get goes to pay the $645 premium for the lousy insurance I had to get once my COBRA ran out, plus my higher copay for my drugs.
I'm not sure what to think about your statement about 'mooching off of the government dole'. Do you REALLY think people feel that way about you?
Sorry, chickie, but you've paid your way and done your best. That's what assistence programs SHOULD be for and NOT for multiple young people having children so that they CAN get benefits. If there weren't so many freaking social programs for the able-bodied, maybe we COULD concentrate on and do better things for those who really need it.
Hi Bandit, I actually will get Medicare right away because they denied me on initial application and its been almost two years already since I initially applied in March of 2006.They give you the back pay and they credit you the Medicare waiting period., because they WRONGLY denied you on initial application.They do this at the ALJ hearing, if one gets approval then. 65% of people who were denied on initial application get approved in front of the ALJ.
I was 54 1/2 when I applied, SSDI uses an antiquated "grid" system and if one does not fit into the "grid" exactly they get denied. I was told by SS that after age 55 you are put into another grid and are approved more easily. If you were over age 55 when you applied you will most likely be approved if your disability meets their listing. My two cousins who have the same spinal issues and Rheumatoid arthritis as I do were actually approved within 4 to 5 months on initial application, BUT they were both over age 55. I am now 56, so I HOPE I get to see the judge soon and get my approval and Medicare.
No I don't think anyone considers me PERSONALLY to be a moocher, but if one reads some of the comments posted about those on Medicaid, they are not very nice, pretty harsh actually.
If doctors wont take new patients or discharge them, then tell them to go see an NP. There are plenty of NPs around in every corner of the country to treat patients. I seriously doubt that anybody has to drive more than 30 miles or so to get to an NP clinic.
As for whether docs should be allowed to D/C patients, then absolutely YES they should be able to. I mean come on what are we talking about? FORCING doctors to treat patients in a non-emergency setting? Thats totally unfair. I dont see dentists being required to treat everybody that comes thru their door. I dont see lawyers being forced to take every single person who walks thru their door as a client. Thats communist/socialism BS and its totally antithetical to a free and fair society.
NOBODY should be forced to take "customers" they dont want (exceptions are race and gender). Every doctor should have the right to decide which patients they want, and which ones they dont want (exception = ER).
Somebody mentioned a law that would require doctors to take X% of their patient panel as Medicaid/Medicare. Thats absolutely insane, and the entire system would collapse if that kind of communist crap passed into law.
In the late 1990s, I saw a therapist who did not take any insurance. You paid up front and filed for reimbursement. That was her decision, and I certainly understood.
And I once saw a spot on a network news program about a family practice physician who did not take insurance - ANY insurance. She charged $3 a minute for her time in the office, and had set fees for other procedures and so forth on a poster in the waiting room. Her office staff provided people with any paperwork needed for insurance filing, but she did not do it.
Here's the kicker. She had to turn people away! A lot of people liked knowing exactly how much they would pay if they saw her.
Also, an increasing number of independent pharmacies are not accepting insurance. What they charge is what you pay, and you can file with your private insurance. Like the aforementioned doctor, they almost have more business than they can handle, for the same reasons - customers always knew exactly how much they would pay.
Requiring that practitioners take any insurance plan makes no sense to me. If you're part of a group practice, that's one thing, but if you're on your own, you can take or not take whatever you want.
p.s. An independent pharmacy in my city has, on more than one occasion, stopped filling Medicaid prescriptions because our state's reimbursement is so slow (up to a year behind :angryfire ) and they just couldn't fill "free" prescriptions forever.
If you're wondering if that state was Illinois, you're right.
At one point, they were more than $500,000 in arrears. Not good.
In the late 1990s, I saw a therapist who did not take any insurance. You paid up front and filed for reimbursement. That was her decision, and I certainly understood.
And I once saw a spot on a network news program about a family practice physician who did not take insurance - ANY insurance. She charged $3 a minute for her time in the office, and had set fees for other procedures and so forth on a poster in the waiting room. Her office staff provided people with any paperwork needed for insurance filing, but she did not do it.
Here's the kicker. She had to turn people away! A lot of people liked knowing exactly how much they would pay if they saw her.
Also, an increasing number of independent pharmacies are not accepting insurance. What they charge is what you pay, and you can file with your private insurance. Like the aforementioned doctor, they almost have more business than they can handle, for the same reasons - customers always knew exactly how much they would pay.
Requiring that practitioners take any insurance plan makes no sense to me. If you're part of a group practice, that's one thing, but if you're on your own, you can take or not take whatever you want.
Years ago, I had a client whose care was reimbursed through through the VA. A lot of my time was spent with him, and payments could take many months. Given that I am in a solo practice, it really hurt. I'm very sympathetic with docs who decide to drop such patients.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
I would like to say that where I work (which is a low-income area) about 40-45% of our total pts are Medicaid. Of the sick visits I see every day, about 70-80% are MCD, and of those about 40% actually need to be in the office (and we do offer a nurse line, where all our pts can call and be helped over the phone before coming in- mostly insurance pts call the nurse line and this is fine. If your child isn't sick enough to need meds, I don't want to waste the time or money of a visit).
We have some wonderful, RESPONSIBLE MCD pts, and I love them. they come on time to the appointments and they are complient with treatments. They are good parents. And then we have the Others. Those who will make an appointment- blocking 15 minutes of my work time and then not show, they don't call to cancel (during which we could re-book the time), they just don't show up (and then they call after hours to the answering service, and I get paiged and they want the abx called in NOW becasue their child is REALLY sick).
I personally (not counting the other providers) on average have about 2-4 no shows in each 4 hours that I work. Each of these no shows cost the practice (I am paid hourly) anywhere from 80-150 or even more dollars. It adds up very quickly. Yes, we can account for the no-shows by double-booking-placing two visits in a slot, but if both show up, that adds for longer wait times for the pts- and no one likes that- and then I get behind on my schedule, etc.
Even though I am paid hourly, so it doesn't matter to my paycheck how many pts I see or charges I set, I feel a responsibility to make a profit for the group. We have ancillary staff, rent, equipment- all of which costs money and all of which I use every day. I also believe that if I see a pt with an ear infection and treat it accordingly, I should be paid by MCD 100% of what a doctor gets, not 80% because I have NP after my name. No difference in treatments/assessments= no difference in pay.
So, I feel that I do have a right to refuse a pt care, if it is the type who is not respectful of my time or is not complient(as I try to be of theirs. I will bust my hump to stay on schedule for my pts). The pt is free to fire me if they don't like the appointment time, my behaviors, etc. It works both ways. What really stinks is that the kids are the ones who need the help, but it is the parents who are the ---holes.
Insurance pts do this too, but with lesser frequency- and believe me, we treat those who do just like our MCD.
I'm a FNP and have worked in both pediatrics and family practice, and my experience pretty much is the same as yours.
Coming in for every little thing- like "he's been vomiting." Twice, two days ago, fine ever since. No-shows- I've seen clinics send reminder cards, call with reminders, etc and still no one shows- until Medicaid is going to be cut off if the physical isn't done, or the school isn't going to allow the kid back in class, or is going to call CPS because the kid's been out a week with no note. Then, it's urgent, it's an emergency, but it's the provider's emergency. Never mind that the parent has made and no-showed appointments.
Scribbler hasn't mentioned this, but the posts on the dentists did- kids who come in and run wild, make a huge mess, tear magazines into shreds on the floor, tear things up, play with the equipment, even play in the red "biohazard" trash- those I'd like to fire. I've had parents not bring their kids back to see me because I won't tolerate misbehavior when I'm right there in the room. I'm not going to try to talk over a kid to talk to a parent, I'm not going to let the kid climb on the furniture or play with the equipment, I'm not going to let the kid hit a sibling, the parent, or me- and some parents get upset about it. Tough. Please, do, leave and find someone else.
Then I once had an adult Medicaid patient I referred to a specialist. The trainee receptionist made the appointment with a doctor who didn't actually take Medicaid, but out of the kindness of his heart he agreed to see her when she showed up at his office. Her adult daughter proceeded to steal a very nice picture frame out of his office!! And we wonder why doctors don't want to see Medicaid patients?
And, just a comment for anyone who thinks that a provider should not ever be able to refuse a patient because of payment issues: there are indeed expenses to running a practice. The utility companies, the medical and office supply companies, the malpractice insurance companies, the office staff, and so forth, all expect to get paid. I expect to get paid. Do you work for free?? On a daily basis? If I'm going to volunteer, I'll do that, but I can't do it every day.
When I worked at the grocery store pharmacy, telling a patient not to come back FOR ANY REASON was a firing offense "because our emphasis is on customer service." I hated it and people who have worked for other chains (even Walgreens :monkeydance::barf01: ) have said that's not the case there.
But we had not a small number of customers for whom doctors would call in prescriptions, and they rarely came to pick them up. We would call the doctors and tell them, and in many cases, we never saw anything from these individuals again.
scribblerpnp
351 Posts
I would like to say that where I work (which is a low-income area) about 40-45% of our total pts are Medicaid. Of the sick visits I see every day, about 70-80% are MCD, and of those about 40% actually need to be in the office (and we do offer a nurse line, where all our pts can call and be helped over the phone before coming in- mostly insurance pts call the nurse line and this is fine. If your child isn't sick enough to need meds, I don't want to waste the time or money of a visit).
We have some wonderful, RESPONSIBLE MCD pts, and I love them. they come on time to the appointments and they are complient with treatments. They are good parents. And then we have the Others. Those who will make an appointment- blocking 15 minutes of my work time and then not show, they don't call to cancel (during which we could re-book the time), they just don't show up (and then they call after hours to the answering service, and I get paiged and they want the abx called in NOW becasue their child is REALLY sick).
I personally (not counting the other providers) on average have about 2-4 no shows in each 4 hours that I work. Each of these no shows cost the practice (I am paid hourly) anywhere from 80-150 or even more dollars. It adds up very quickly. Yes, we can account for the no-shows by double-booking-placing two visits in a slot, but if both show up, that adds for longer wait times for the pts- and no one likes that- and then I get behind on my schedule, etc.
Even though I am paid hourly, so it doesn't matter to my paycheck how many pts I see or charges I set, I feel a responsibility to make a profit for the group. We have ancillary staff, rent, equipment- all of which costs money and all of which I use every day. I also believe that if I see a pt with an ear infection and treat it accordingly, I should be paid by MCD 100% of what a doctor gets, not 80% because I have NP after my name. No difference in treatments/assessments= no difference in pay.
So, I feel that I do have a right to refuse a pt care, if it is the type who is not respectful of my time or is not complient(as I try to be of theirs. I will bust my hump to stay on schedule for my pts). The pt is free to fire me if they don't like the appointment time, my behaviors, etc. It works both ways. What really stinks is that the kids are the ones who need the help, but it is the parents who are the ---holes.
Insurance pts do this too, but with lesser frequency- and believe me, we treat those who do just like our MCD.