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medpundit |
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Sunday, September 26, 2004I was asked if I would be willing to take on a new patient who was deaf and needed to have a sign language interpreter with her at each visit. I accepted, knowing that I would end up breaking even at each visit once I paid for the interpreter. The patient had traditional insurance, which would pay me about $50 for a fifteen minute office visit, and the interpreter services charged $25/hour with a two hour minimum. But now, my patient has switched to Medicaid, which pays I don't know how much for a fifteen minute visit, because I've yet to be paid. But you can bet it will be less than traditional insurance. In an added blow, the interpreter services have raised their rates to $30/hour with a two hour minimum. I'm no longer breaking even. I'm paying for the privilege of caring for my patient. I know that the charitable and kind thing to do is to ante up and not complain. Even as I write this, I feel miserly and mean. But my patient has turned out to be a somatisizer. She's also started recommending me to her friends in the deaf community. This has the potential to turn into some very serious giving. And I can't put a halt to any of it without breaking the law. Now, my patient is not illiterate. She could communicate with me through writing, but she prefers sign language. English isn't her first language, sign language is. And although the portion of the ADA relevant to the hearing impaired includes written materials as an appropriate aid, the reality is that written material may be considered inadequate. And, although the law also says that a business doesn't have to comply if doing so will be a financial hardship, the reality is otherwise. Physicians can not plead poverty. (A similar situtation exists for foreign language interpreters although the feds have cut small practices some slack in that regard. ) The most frustrating aspect of it all is that I have no choice. I have to give and give again, even if the giving exceeds my capacity. Charity given freely is at least attended by some warm and fuzzy feelings. But forced charity feels more like being robbed. UPDATE: Another physician had a similar experience: I, too, became a "victim" of the ADA , and I was forced to stop accepting Medicaid because of this. When I suggested that the patient might be better served by going to one of the two local family practice residency programs where there were full-time institutional supported American Sign Language interpreters, I received a letter from an attorney from a local disability advocacy group threatening to sue me if I did not treat this patient. After consulting with two attorneys, I was basically told to "suck it up and see the patient" because I had no defense against an ADA suit. The patient turned out to be a nice enough person, but I realized that a couple of dozen patients for whom I would have to pay for an interpreter could financially destroy my practice. Even though there are institutional practices in the community with employed interpreters, the ADA states that I am obligated to take any patient like this one unless my practice is closed to all patients. Therefore, my only recourse was to terminate my contract with Medicaid. About 100 patients were forced to find a new doctor so that I could protect my practice from financial ruin. Sadly, this is one of the alternatives I'm considering. It means that some of my patients will have to find a new doctor, and it isn't easy to find doctors who accept Medicaid. It's one of those government mandates that's meant to improve care but only ends up making things worse. UPDATE II: In a related vein, Dr. Mental notes that doctors in Tennessee had to drop Medicaid when the state expanded its program to include all the uninsured. Which, by the way, is Senator Kerry's plan for the whole country - to expand Medicaid to include families making 200% of the poverty level. We'd have fewer uninsured, but they'd have a heck of a time finding a doctor. posted by Sydney on 9/26/2004 09:59:00 AM 0 comments 0 Comments: |
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