By Michael Ciampi, M.D. — As the Maine Legislature and the public debate Medicaid expansion, there an aspect of the equation that has not been mentioned, but needs to be considered.
Because the Medicaid system is so inefficient, because it puts so much administrative burden on doctors, and because their payment rates are so low, most private doctors have made the difficult decision not to accept Medicaid patients. They came to the realization that they were actually losing money for each patient they saw who was covered under this government program. If you are losing money with each patient, you cannot make it up with more volume.
It is a simple matter of econonmics. A doctor’s office is a small business. If it loses too much money, it will shut down. There have been several examples over the past few years locally where local doctors have had to shut down their practices and either join big box medical groups or move out of state, often because of Medicare and Medicaid rates being so low.
One might say, “All doctors are rich. They can afford to lose a little money here and there. It’s for the public good.” The truth is that while reimbursement for services has been essentially flat for the past 12 years, while expenses (payroll, malpractice, health insurance, lights, heat, etc.) have gone up at least 30 percent or more. Few primary care doctors are thriving today. Giving away services is not an option for most if they want to make a living and pay their employees. If a doctor can’t stay in business, he/she cannot help anyone.
An example of the undue burden that Medicaid places on small practices is that, when a physician accepts Medicaid, if a patient with that coverage calls for an appointment who needs an interpreter, the doctor, at his expense, must be sure there is one there. If the patient comes in for the appointment, what he will collect from the state is not even enough to pay the interpreter. If the patient does not show up, the doctor pays the interpreter anyway, at an even bigger loss. No other business would put up with this. Why would a doctor’s office?
Big hospital clinics are allowed to bill twice what private doctors can for Medicare and Medicaid services. Those clinics will be the only ones which will be able to afford to see this population of patients. Care in those clinics tends to be impersonal, generic, and much more expensive. Often patients do not see a doctor, but a nurse or physician’s assistant. Even then, they often don’t see the same provider twice.
Many private doctors would rather see a few patients without insurance and either give them a discounted rate, help them with a payment plan, or see them for free as an act of true charity. Unfortunately, financial pressures are making this harder to do. Once a patient goes on Medicaid, that option is essentially eliminated.
Voting for Medicaid expansion is a vote to further weaken our healthcare system by accelerating the decline of the neighborhood doctors that had been the backbone of medicine in years past.
If you are OK with the extinction of your local family doctor’s office, then vote for Medicaid expansion. But remember, the next time you need to be seen, take a number and have a seat. Someone will be with you…whenever.
Michael Ciampi, M.D., runs a cash only medical practice in South Portland, Maine. Ciampi Family Practice has drawn national attention for its innovative approach to delivering health care. (Note: This column originally appeared at RayRichardson.net. It is reposted here with permission.)
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