Radio Raheem. Do the Right Thing. Spike Lee. 1989
Says Da Mayor. As a fresh grad, questioning in network vs out of network, it struck me that some doctors explicitly skirted the issue while others adamantly argued for OON and sticking it to the man. Next question. Will grandma benefit from your expertise? Worse still, Medicaid! After five years I still can’t figure out what’s what. With the ACA looming, the profession must face a changing healthcare market, new paradigms of care reflecting value based systems and significant increases of insured patients. The numbers of chiropractors that take medicaid must rise as well.
I previously wrote about the challenges of parity in terms of reimbursement and questioned the profession’s collective perpetuation of unfair and constraining reimbursement practices. We are competing to “treat” the 8% that utilizes our services when the rewards of caring for the 92% slip through our fingers.
Does your chiropractor take medicaid?
Kaiser reports that Medicaid is the largest provider of healthcare in the country with many more en route. You’re a numbers guy?! Me too. That’s 60M or about 20% of the good ‘ol U, S of A. I had avoided Medicaid patients because of the perceived stigma. Not to mention the INSULTING reimbursement rates. Don’t feel bad. Many doctors avoid Medicaid. An article in Medscape brought this to my attention.
Dr. Tunzi, wrestles with this dilemma in a schizophrenic fashion. His conclusion: physician success is a societal sequela. As such, public service is a necessary extension of the social contract enjoyed by physicians. Granted, Dr. Tunzi addresses the other side, but our profession has brawled for “physician status.” Some docs travel abroad on noble missions to bring chiropractic to the less fortunate of the world while some 56M necessitous, insolvent, hardscrabble folk subsist stateside.
Medicaid will cover more backs. An estimated 30M more. The cost of treating back pain has not improved. Many of the eight percenters are straightforward cases. In contrast, the few cases seen to date are case worthy. If you have insurance that no one accepts are you covered? Many of our neighbors are neglected or written off. The biomedical approach for treating back pain is not working and now it will not work for more people. These patients will need guidance. We can help.
If this sappy plea does not stir your pot consider a pragmatic reflection. ACA mandates increased Medicaid coverage for individuals earning up to $15K/yr, $20K for a family of three or $24K for a family of four. On a side note, citizens earning up to four times the poverty levels ($46K) are eligible for real time tax credits that can be applied to reduce monthly insurance premiums. The law aims to capture half of the uninsured or some 30M people. 30M less cash patients! Right, what does that matter, they are in the 92% bracket we don’t treat. But, Medicaid reimbursements are expected to rise to Medicare rates at least for primary care physicians and a select few. Granted the life of this incentive is unclear.
On a brighter note, 2014 brings increased Medicare reimbursements. Imagine if Medicaid reimbursed at Medicare rates. Would that change your tune?
The future of the insurance industry
Should our profession collectively take it on the chin? Would you take one for team Chiropractic? Could eating the short-term loss set the stage for long-term gains in governmental reimbursement parity? Should we parlay our participation in federal programs into a broader insurance reimbursement package as primary spine care providers. We certainly bill the hell out of private insurance and personal injury. Yet, how can we ask for parity on services we don’t provide? You don’t have to be an ivy-league health economist to deduce the hypocrisy of that premise.
Hold up, you say. Citizens can opt out of insurance, pay the federal penalty and front cash for services they want. At least 26M will. This option is better for some including those not eligible for Medicaid or other Obamacare edicts. That works until penalties exceed insurance premiums. Yikes! “I work very hard taking care of my patients. What do you want from me?” Refer back to Dr. Tunzi and heed Da Mayor.
Before branding me a socialist mull over the argument. This logic may be state specific but in terms of federally funded programs broadening your practice base may be worth revisiting. Don’t open the floodgates but what’s a few drips. Hijacking Mr. Zinsser’s unwittingly appropriate words, “the insurance industry is trying to rewrite its policies in less disastrous English what redress will be ours when disaster strikes.” Cost-benefit analyses are looming. Federal reduction of blanket Medicare/Medicaid payments for surgical and invasive procedures have started. ACA is not going away. Blame what you will. As for me, I am a survivalist following Da Mayor’s counsel. NJ Spine Doc over and out.
Special thanks to the proofreading team: Dr. Kristi Aldridge and Dr. Paul Gardner.
References:
- Do the Right Thing. Spike Lee. 1989. http://www.imdb.com/title/tt0097216/quotes
- Tunzi M. Health Reform and the Uninsured. The New Requirements of the Old Ethics. The Hastings Center Report. 2013;43(2)
- Gordon E. How will the Affordable Care Act Affect Medicaid in Pa, NJ and Del? Newsworks.org JULY 24, 2013 OBAMACARE: THE SHORT ANSWER (http://www.newsworks.org/index.php/local/healthscience/57622-how-will-the-affordable-care-act-affect-medicaid-here)
- Murphy D. Clinical Reasoning in Spine Pain. Vol 1. Primary Management of Low Back Disorders Using the CRISP Protocols. 2013
- Zissner W. On Writing Well. The Classic Guide to Writing Non-Fiction. 30th Anniversary Ed. 2013.