Running on empty: How physicians cope with Medicaid

Medicaid cuts are pushing doctors to the brink, but some are developing creative strategies to serve their neediest patients.

By Joel B. Finkelstein, AMNews staff. July 7, 2003.

Less time with family and friends. Fewer hours to rest and relax. More money worries and paperwork. And most of all, more stress.

"This is not what I was expecting for my 50th birthday," said Rosanne Hooks, MD, a family physician who has served Marion County, S.C., and the surrounding area for the past 20 years. "But I love my work in this rural, underserved community."

Her sentiment sums up the reason that many doctors continue to serve Medicaid patients despite the barriers and dwindling practice revenues.

As one of the largest items in states' budgets, Medicaid is an unavoidable target when hard times hit and legislatures seek cuts. Unfortunately, this simple fact does not make it any easier for physicians who work with the program to balance their own books.

Never an easy task, serving Medicaid patients has become increasingly difficult as budget cuts and bureaucratic hurdles are added to the equation. Physicians have seen reimbursement cuts or freezes in most states even though the program already pays well below market rates.

"At one time, the requirement was just to treat patients, but now there are increasing responsibilities without increasing reimbursement," said family physician Melvin Gerald, MD, who serves Medicaid patients at practices in Washington, D.C., and Columbus County, N.C.

Stringent requirements for documenting prescriptions, specialist referrals and missed appointments force these physicians to spend more time filling out paperwork, following up on unfilled scripts or doing myriad new jobs Medicaid asks of them.