Question

1. Dr. Jeff has cared for patients on Medicaid since he began his career as a physician in 1973. Through a state mandate, all Medicaid (MA) recipients have been placed in a managed Medicaid product. Dr. Jeff has one such patient, Mrs. Miller, who has been progressively losing weight. Dr. Jeff contacted the insurance provider to authorize a CT scan of the abdomen to rule out a gastrointestinal or gynecological abnormality, however the insurer approved an ultrasound instead. The results of the ultrasound were positive for hydronephrosis (fluid in the kidney), a significant abnormality. Dr. Jeff requested a CT scan be performed. A decision to allow the CT scan took three weeks to be made. Mrs. Miller was found to have cervical cancer with metastatic disease to her pelvis. Dr. Jeff has been increasingly frustrated by his inability to access appropriate services to his managed MA patients that he has decided to withdraw as a participating provider. Mrs. Miller’s case was not the first in which he felt a clerk usurped his recommendations. How have the state’s policies mandating managed Medicaid impacted the physician? Why were such policies implemented? What can be done to encourage physicians from contracting with managed MA companies? What alternatives will Mrs. Miller have if Dr. Jeff leaves the program?

Answer 1

How have the state’s policies mandating managed Medicaid impacted the physician?

The government made it Medicaid in such a way to reduce the fees and expenditure inflation and to get improved access to health care and health-related outcomes. These policies help doctors or physicians to put some liberations in their health care practices in terms of costs.

Why were such policies implemented?

These policies are implemented to provide health coverage for older adults with no income who are over 65 years or people with disabilities. The main purpose of these policies is to provide health coverage and reduction of healthcare-related costs.

What can be done to encourage physicians from contracting with managed MA companies?

Dr Jeff can be encouraged to have peer to peer consultation to come up with a final decision. Moreover, in this case of an ethical dilemma, Dr.Jeff can be encouraged to go with the Medical Committee of the organization and can finalize his decision accordingly.

What alternatives will Mrs Miller have if Dr Jeff leaves the program?

In this scenario, if Dr Jeff leaves the program Mrs Miller has to consult with another physician in the network for the continuity of care.