Posted by: notdeaddinosaur | January 22, 2015

Nice Picture

It’s kind of amazing how a big colorful picture can dominate a news story even when it has precious little to do with the subject at hand. To wit, this image:

DrLucy draws up a flu shot

now graces the top of page A3 in today’s Philadelphia Inquirer, illustrating an article headlined:

Paid more, doctors saw more Medicaid patients, Penn study finds

In other news: Water is wet.

Pardon my snark. I suppose demonstrating things that are intuitively obvious can be useful at times. Especially when dealing with the government, which includes large numbers of people who refuse to believe just about anything that hasn’t passed across their desk in triplicate.

So the big news for the day was that there is now actual evidence that increasing payments (not “reimbursements“!) to doctors allows us to provide care to people for whom we would not otherwise be able to do so. Able; not just willing. However, as I am quoted somewhat extensively toward the end of the piece, for many of us it wasn’t enough.

Here’s why, though (and this didn’t make it into the article): that $35 quoted as an office visit payment from Medicaid is a fiction, at least in my state. See, Pennsylvania administers Medicaid (it’s called “ACCESS”; Orwellian, isn’t it?) entirely through managed care programs. Capitated HMOs. There is no way for any doctor to get paid fee for service for Medicaid in Pennsylvania. Apparently they publish fee schedules to fulfill ACA requirements. But whenever I try to bill for my services, all I get is a rejection with the notation, “Member is eligible for a managed care program. Please contact the appropriate program.”

I joined in with the nascent HMO movement back in the early 90s, right when I was starting up my practice. At the time, they were the only shows in town. I hated them because of the way they kept trying to force me to balance my own bottom line against the welfare of my patients. I pretty much always came out on the side of the patients, but the resentment towards the insurance companies was deep and abiding. I only participate in two of them these days, and only because I am required to by an “All Products” clause in my contract. (If I don’t take the HMO, I can’t participate in the PPO.) But long ago I made the business decision not to join any more of them. Guess what: that includes all of Medicaid. Oh well.

Make no mistake. It’s a fine article and I’m very pleased to be part of it. So today my picture is in the paper. Why? Because I was able to pull a still image out of a video from 2012, crop a screen shot and get it in by 5:00 pm. Also because I’m a scintillating interviewee brimming with pithy quotes, of course. But after this news cycle ends and my 15 seconds of fame are over, I’ll still be here, longing to provide care for the less fortunate in my community but not willing to go broke doing it.

That’s my story.



  1. And you’re sticking to it…but I know you have cared for patients who have no insurance or money…lu


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