Almost a third of physicians don’t accept Medicaid patients. Most offer the same reasons: Medicaid reimbursement rates are typically lower than other insurers and the documentation requirements can be burdensome. Many providers also find their Medicaid patients are more medically complex and often fail to comply with treatment. Because many have unstable employment, transportation and housing situations, they tend to have the highest rate of no-shows, costing the United States as much as $150 billion a year.
In short, many providers feel that Medicaid patients require the most effort while delivering the least revenue – and in our era of physician burnout, these providers are looking for patients who offer the opposite.
The Cost of Complexity
The Medicaid referral process can also put up roadblocks. New England Journal of Medicine (NEJM) Catalyst reports that getting a Medicaid patient from a PCP to a specialist often involves a multitude of staff and systems. From misplaced faxes and handwritten notes to EHR systems requiring more than a dozen documentation steps, patients often fall through the cracks – or wait so many months for a specialist appointment that they forget about it. In the end, only 16 percent of Medicaid patients referred to a specialist end up seeing one.
It’s no wonder many healthcare professionals view Medicaid care plans as a cycle of lost income, missed treatment and wasted time.
But there’s another repercussion people don’t always like to talk about. When providers avoid treating Medicaid patients on a large scale, the medical industry is effectively assigning care based on income and social class. In addition to the ethical implications, it means that a large number of Americans are struggling to get help. 76 million people – 1 out of 5 people in the United States – are on Medicaid. That number will rise to 82 million by 2026.
Fortunately, there’s a solution that can benefit both provider revenue and population health: telemedicine.
Solving Medicaid Challenges
While virtual health can’t solve every Medicaid issue, it can dismantle many typical roadblocks:
- Providers and patients can meet as scheduled even if the patient has missed their bus or had a childcare cancellation. The Pew Research Center reports that in 2017, 67 percent of people with incomes of $30K or less had a smartphone, indicating that most Medicaid patients have a way to complete a telemedicine visit.
- Digital appointment reminders, self-scheduling features, mobile apps and other online tools can help reduce no-shows and keep patients engaged and motivated.
- Remote monitoring can increase medication and care plan adherence or alert providers of a spike in blood pressure or other need for intervention.
- Instead of delaying preventive care visits and relying on more expensive emergency room visits, patients can maintain a more consistent treatment plan with their primary care provider.
- Medicaid is the largest payer for mental health services in the United States. Virtual care can appeal to behavioral health patients who fear the perceived stigma of visiting a psychiatric facility.
Improve Medicaid Reimbursement
1. Find out your state reimbursement policy.
Every state Medicaid program provides reimbursement for some form of live video in Medicaid fee-for-service; some also reimburse for store-and-forward telemedicine and/or remote patient monitoring (RPM.) Check a resource like Center for Connected Health Policy to find out the specific rules in your state.
2. Identify suitable Medicaid patients in your practice.
Include the ones most likely to be no-shows and find out if virtual care is an option for them. Schedule them for telemedicine visits while you reserve your exam rooms for commercial and Medicare patients.
3. Delegate Medicaid patients with low-acuity issues.
Depending on your state laws, nurse practitioners and other mid-level clinicians may be able to work to the top of their license by seeing these patients for you. The physicians in your practice can focus on providing services for patients with more complex issues, bringing in more revenue.
4. Hold remote specialty consults while the patient is in your office.
While this isn’t always possible, it can eliminate a complex referral process and an additional visit for the patient, while facilitating faster treatment.
5. Expand your patient volume.
Without investing in additional office space, your providers can see a higher number of Medicaid patients and expand their presence in the community through remote visits.
6. Increase your number of appointments.
Instead of losing revenue to urgent care centers at night and on weekends, offer after-hour appointments from home.
Improving Care For Medicaid Patients
Medicaid patients deserve the same care and compassion as anyone else. A strategic virtual health program can help providers sidestep typical frustrations and provide much-needed services to this population – without a loss in revenue.