02/05/2016    Michael M. Rosenblatt, DPM

Gross Underpayment of Medicaid Surgeries--an Attack on Access to Care

In a study authored by Dr. Charles Mabry of the
University of Arkansas in Little Rock and
colleagues in the Journal of the American College
of Surgeons, Dr. Mabry reports that: "When
Medicaid fees are too low relative to payments
from Medicare, doctors may refuse to treat
Medicaid patients, potentially making it much
harder for poor people to get treatment."

As recently published on Medscape:
http://www.medscape.com/viewarticle/858036?
nlid=98684_984&src=WNL_mdplsfeat_160202_mscpedit_
surg&uac=38931PG&spon=14&impID=977993&faf=1

Some of the results of the study showed shocking
underpayments to surgeons: "When they looked at
mastectomies, often done for women with breast
cancer, Medicaid paid $226.47 in Connecticut, 69
percent less than the $725.35, Medicare payment
for the same procedure in the same state. For an
enterectomy, typically done to remove a tumor or
obstruction in the small intestine, New Jersey’s
Medicaid payment of $332 (which) was 75 percent
less than the $1,343.16 payment under Medicare."
There are many other examples, some even worse.

Editorially, it appears that podiatry is "lucky"
to be excluded from Medicaid. But our patients
are not so lucky, because it has been proven that
primary podiatry care helps prevent amputations,
often for a pittance compared to the costs of
untreated complications.

This overview suggests a dire legislative
attitude. It appears to be a Darwinian
legislative directive to encourage Medicaid
patients to die. This conclusion seems extreme,
but appears inescapable, based upon the facts.
Those very same legislators will hardly be
willing to lunch at a low-cost restaurant. Yet
they expect physicians to work for literally
nothing. Do they care about physicians or their
Medicaid patients? You be the judge.

Michael M. Rosenblatt, DPM, San Jose, CA

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