Wednesday, July 11, 2012

Dear Medicaid:

Dear Medicaid:
     I have considered it a privilege and my duty to be a physician to patients from all sectors of society, including those with Medicaid, the state-managed, tax-funded insurance for the disabled and indigent.
     Therefore I was surprised to learn this week that I am being "written up" by Medicaid officials for failing to be available to Medicaid patients twenty-four hours a day.  
     One of your supervisors, whose job it is to provide surveillance of physicians--making sure we don't break Medicaid's rules--informed me that if I didn't change my answering machine message to tell Medicaid patients how to reach me at any hour of the day or night, every day of the year, I would not be allowed to see Medicaid patients.  She suggested I provide my home and cell phone numbers on the after-hours voicemail for the clinic.  She also warned me that Medicaid officials would be making "test calls" when my office was closed, to make sure the message had my personal phone numbers, and to note that I was answering the phone personally.
     I had trouble believing that Medicaid's assumptions about physician availability had not been modernized by the introduction of emergency rooms and urgent care centers all over the country. Moreover, I just knew Medicaid officials couldn't possibly believe the old-wives' tales about physician omnipotence.  You do know we need sleep, right?  And that solo physicians--not clannish by nature--do not participate in big groups for telephone back-up?  You must realize that doctors no longer have wives keeping house and cooking dinner, in order that we might dedicate ourselves exclusively to our callings. 
     So I called the supervisor who had reprimanded me, the one who threatened to take Medicaid away from my office.  It took twelve months for our twenty-page Medicaid provider application to be approved--I don't want that effort to go to waste!  And the Medicaid fee schedule--which pays at one-third of the standard insurance rates, and doesn't even cover office overhead for these patients--is still better than nothing, isn't it?
     "I can't possibly provide twenty-four hour care for Medicaid patients," I explained.   
     "What I hear you telling me, Dr. Colasante," the supervisor said, "is that you wish to be removed from the Medicaid provider list."  She seemed polite, but spoke firmly.
     "No," I contradicted her.  "I'd like you to update your requirements for doctors.  I am a solo doctor.  I am one person.  I can't meet your requirement to be available all the time.  Is it not enough for me to have convenient office hours and a walk-in clinic every day?  Is it not enough for me to be a trained, competent, Board-Certified physician who cares about all my patients?"
     "It's not enough," she said.  "You need to be available twenty-four hours a day."
     "Really?"   I asked.  "Are you available twenty-four hours a day?  Are you and I so different?"
     "These are the rules.  They're in the Medicaid Provider Handbook."
     "Can the rules be modernized?"  I wanted to know.
     "Our legislators made the rules, and I can't change them," she said.  I was starting to feel her exasperation.
     "Why can't I simply instruct patients with an emergency to go to the emergency room?"
     "You need to provide an alternative," she explained.  "Besides, what if another provider, like the emergency room, should need a Medipass authorization number?  You need to provide the authorization number."
     '"You mean you want me to be available day and night to provide a number to emergency room doctors, so that they will be allowed to see my patients when there is an emergency?  Will the emergency room doctor wait for a special number from me before treating a patient?"
     "Yes, that's how it works," she said.  
     "The majority of Medicaid patients in Gainesville live on the east side of town, where I practice," I informed her.  " I am the only private family physician for miles around who accepts Medicaid.  Why do you want to dismiss me as a Medicaid provider, on the basis of an administrative point that doesn't make sense?"
     "We do not want to dismiss you.  But if you don't change your message machine to include your home phone number," she said with finality, "we will not renew your Medicaid contract."  
     Then, as though reverting to a prior life, a life before me, before I started to make trouble, that rosy time before this phone call, she said cheerily, "Have a good day!"
     This is why, Medicaid Authorities, I am letting you know that your Medicaid Provider Handbook (which is 224 pages and too full of legal language to read ) needs a few changes, especially the archaic rule about twenty-four hour availability for doctors. 
     Your speedy action with regard to this matter will permit solo docs like me to keep seeing Medicaid patients.  
                                                                                                      Ona Colasante MD

PS:  My home phone number has been listed in the telephone book for twenty years.  

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