By skyforbes 
There has been some recent interest in whether the University of Colorado takes enough Medicaid patients. To state it more spectacularly: many are concerned that the shiny billion dollar Anschutz medical campus (the University part) doesn’t serve the poor people who live across the street.
I helped remediate the Fitzsimmons base 15 years ago, before it was a medical campus (when I was an environmental engineer), I went to med school at that University before and after it moved there, and I now practice very close to there. I am a private family doctor located one mile west of the University of Colorado campus. I see 80% Medicaid patients, and most of the rest are uninsured. I would ideally send all of my patients to the University for specialists.
There was a meeting last week (October 30, 2014) where alot of people with lengthy titles and letters after their name all sat in a room. I estimated that the time of all the folks there, based on pay, was worth about $6,000 (equal to the payment from 100 Medicaid visits in my office). As expected in such a large meeting, I’m not sure that anything concrete came out of it. Well, awareness was increased, including a nice article: http://www.healthnewscolorado.org/2014/11/06/primary-care-providers-beg-university-hospital-open-your-doors/
Only about 5 people in that meeting were practicing providers. Two were NPs who run their own awesome clinics. A couple more were physicians who are in leadership roles in large institutions. I was the only full time small private family physician there; and actually the closest family practice to the campus.
I do all of my own referrals. I mean, I pick up the phone myself, and call the departments, and then fax stuff if needed. No one helps me with this. My PA does all referrals herself too. I average 30 patients a day, almost all Medicaid, so I frequently make Medicaid referrals to University. Therefore, I feel I have a pretty good idea of which departments at University are easy or hard to get into, for a Medicaid patient. The two NPs at the meeting would also have an accurate idea, but I don’t think that anyone else at the meeting would have such personal ground level experience with this exact issue, which the meeting was called together for. With that background, here is my assessment:
A REPORT CARD ON MEDICAID ACCESS TO SPECIALISTS AT UNIVERSITY OF COLORADO by me
Easy to get into for Medicaid: ENT, Wellness Clinic, Ophthalmology (Lions Eye Institute), OB, Gynecology, Gyn Onc, and General Surgery.
Most of these are ridiculously easy to get into. For example, call for an OB appointment right now: they ask minimal info on the phone, no faxes required, and the appointment is within a week or two. Most answer within a few rings, and don’t even close their phones for lunch; you can tell they run efficient patient-centered operations.
Yes gen surg is easy. That article linked to above quotes that one can’t remove a gall bladder; I disagree with that note, since I find it easy to send my “choles” to the U.
Update in late 2018: University General Surgery has a policy where they readily take any Medicaid patient who has a home address anywhere in the state of Colorado, except a Denver address. How’s that for a barrier to care? They think that everyone who lives in Denver can get into Denver Health, which is false.
Almost impossible to get into: Endocrine, Cardiology, Rheumatology, Allergy, Immunology, Podiatry, Orthopedics, Gastroenterology, Neurosurgery.
Most of these have long hold times with elevator music, ridiculous back and forth faxing, review and approval by a provider, waiting lists, etc. I’m guessing this stems from some limit they are putting on taking Medicaid patients, but anyway, I don’t use them. I can’t. I send my patients elsewhere in the metro area (I won’t tell you where!), or even sometimes to Colorado Springs (almost no ortho in Denver takes Medicaid).
Absolutely Impossible: Dermatology, Neurology, Urology. Don’t waste your time.
How hard could it be for a Dermatologist to see a Medicaid paitent?
Here is some math. On average, it seems to me that Medicaid (without Medicare parity) pays about a third less than Blue Cross. If a Dermatologist would see even just 5% Medicaid patients, then 5% of their income would go down by say 33%, for a total drop in income of say 1.65%. Salary.com tells me that a Dermatologist makes about 300k. This 5% Medicaid panel would drop their income by about $5,000 to $295,000. And they won’t do it! Nevermind that their tax rate is like 40%, so their take home only goes down by 3k. Take it a step further, and you can reckon that taking 25% Medicaid would drop their 300k salary by about 25k, to 275k. That is surely too little pay. Most of these folks wrote on their med school applications that they want to help the underserved (I helped review med school applications once; most are the same).
I am basing this math on my own familiarity with every part of the billing process. I did all my own billing and posting until recently, and I created all my own systems for chasing payments, so I know much more about this topic than most providers. Just like most providers don’t know much about referrals, they also don’t know much about the finances. I’m not bragging, just giving background on why I claim to know this stuff.
Ok, some may say that my logic only holds for the visit (the E&M CPT), not the procedures, and that Medicaid pays way less for procedures. Fine, do the math on what it would take to see 5% Medicaid at 50% less reimbursement. Or maybe my logic doesn’t include overhead. That was a real nice conference room at University that I was in last week.
I rotated at a large local Orthopedic practice during residency, at two of their metro locations. In between patients the docs talked about their awesome new cars. I challenged one as to why they don’t see Medicaid patients, and he replied that it doesn’t fit with their business model.
There are two ways these University of Colorado departments could take more Medicaid patients. One is to pay the docs slightly less. The other is to be more efficient. This is not hard to do. As someone who has built my own medical practice, doing underserved medicine profitably in a traditionally nonprofit world, I am amazed at the overhead wastage in most medical settings. These departments need to look at their flow, and trim some excess. No, don’t spend more $ paying a consulting company to figure it out, just look at it yourself and cut the excess.
The U responds that they provide $371M or so in underserved care, but this number includes CICP (which they get paid for), and this is “gross charges,” which we all know is a meaningless term in healthcare. I can bill Medicaid $2,000 for every visit, but by contract they will pay me $50 regardless; this doesn’t mean I do $1,950 in charity. Don’t try to fool us with meaningless numbers.
Why do we even hold Blue Cross as the standard? You don’t build a business by considering the most you might possibly make, and then have your expenses rise to meet that. You build a business by keeping expenses as low as possible, then taking any income over that. Medicaid is profitable. Blue Cross is 50% more profitable (rather than saying Medicaid pays 33% less). When I see a Blue Cross patient I consider it a little gravy; but I keep my mission of serving the masses. People insured by Medicaid, Medicare, the VA/Tricare, or other public benefit systems make up about a third of this country.
The University of Colorado could simply post, on their website, the percent of Medicaid taken by each specialty department. Post all numbers on the same page, side by side. Let’s see what happens. Would any department risk the embarrassment of having a low number? Also, post on that same page the breakdown by insurance type for Coloradoans, which I would think is a good goal to hit. Then take the % of Coloradoans on Medicaid as a goal. Actually, first subtract out the kids and Vets who go next door, then figure the % of the rest who are on Medicaid, and the University departments should take that % (I think it would be 15–20%). All University departments should strive for this. I don’t care that UCH and UPI and other TLAs (three letter acronyms) are different entities. If they are at the University, and using the name “University of Colorado”, then the public perception is that they are a “Colorado” level institution that should represent and serve the people of “Colorado” equitably. And really, they shouldn’t go above that % either, because that displaces insured people, who have the same human right to receive care. (Or maybe they should go above as a matter of honor, because insured people have other places they can go).
So there aren’t enough urologists in this city? Make rich and poor people wait (and die while waiting) equally for a urologist; don’t make poor people wait longer. As it stands right now, the “University” (whatever that is) doesn’t discriminate based on gender, sexual orientation, etc, but it does discriminate based on income level, because of this issue.
As an update, on 12/10/14 Icalled U Urology for an appt with Medicaid, and was told next available which was June 2, 2015. I asked what if patient had private insurance, and was told next available is few weeks.
Not taking Medicaid and uninsured patients favors the service of rich people, most of whom are rich white people, which almost everyone in that meeting last week was (I’m a rich brown person). This makes it a racist and classist medical practice, like mine (I only see refugees) or Stout Street (they see homeless), but I don’t call myself the University of Colorado, so I have a different standard. I have listed the University of Colorado departments above that are guilty of this discrimination based on class.