Dr. Rosen:       What’s new in Obamacare this week with the welfare patients being placed in HMOs?

Dr. Dave:         The oppression is beginning early. We had eliminated referrals from what appeared like HMOs except for the little Medical mark after the HMO name.

Dr. Rosen:       We had an outside business consultant review our finances. My attorney had advised me to close my practice since it was no longer profitable. I would like to practice another ten years or so.

Dr. Ruth:          Did you find any useful information?

Dr. Rosen:       We found out our HMO was paying us about 70 percent of our fee. We found that Medicare was paying us about 60%. Most private insurers were paying us between 50% and 70% of our usual and customary fee.

Dr. Dave:         What’s surprising to me is that Medicare is still paying you more than 50%. The last time we looked at our surgery reimbursements, Medicare was at less than 50%.

Dr. Patricia:      We’re getting about the same from Medicare. It’s always over 50% and it fluctuates to over 60% at times.

Dr. Sam:          That’s why I don’t participate in any government plan whether it’s Medicare or Medicaid. The arrogance of their paying bills at whatever level they wish. Aren’t we the only profession that tolerates such discrimination?

Dr. Rosen:       Sam, putting the discussion in that frame of reference, reminds me that the biggest surprise was the Medicaid program. We didn’t average even 10% of our fee.

Dr. Sam:          Looks like you’re finally waking up to government medicine.

Dr. Rosen:       It even gets worse. Of the seven Medicaid patients we saw the last quarter, our total income was $25.

Dr. Ruth:          That’s not even the cost of billing!

Dr. Rosen:       That’s precisely the point I was leading up to. We then decided not to bill the state for their welfare patients. We will see them totally as charity.

Dr. Patricia:      That’s the only way that the patients will see it as charity. As long as you bill, they’ll think that you’re making money. They can’t conceive that you’re losing money. In fact they think that your $25 for seven patients is income. That doesn’t covering one hour of staff time to provide their services.

Dr. Rosen:       When Dr. Sanford, who was the president of the Union of American Physicians and Dentist, spoke to our group in the 1970s, Medicaid patients receive two small stickers about a quarter inch by a half inch per month, he said he would never stoop to such an insulting menial task as the paste these to an insurance form and told all his Medicaid patients that he would see them free as often as they needed him.

Dr. Milton:       I also remember him saying that they were more appreciative of his services when it was real charity.

Dr. Ruth:          It’s basically charity either way. But as long as you’re losing the cost of billing, and each patient costs you the price of billing with essentially no income from them, the patient is a liability.

Dr. Milton:       The patients don’t see it that way.

Dr. Ruth:          The State doesn’t see it that way either. They see a $100 fee and pay the doctor $10. This obviously means that doctors are charging their patients ten times what they’re worth and that’s why doctors are rich.

Dr. Rosen:       So I think we’ve come to the consensus that it’s probably not financially advisable to even bill the State for Medicaid patients. And it’s even a bad public relations endeavor. Maybe that’s also why we see such hostility from state employees.

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