Florida’s HMO medicaid system is in full cardiac arrest!

I was naive and truly believed that the transition from the traditional medicaid to HMO privatization would help pediatricians. In fact, to the contrary, pediatricians are more worried then ever that they will be overrun as this HMO train wreck marches forward enrolling kids and without a captain at the helm. As a Florida medicaid provider for over 11+ years ,I reliquished my participation in the traditional medicaid program in 2008 and characterized the environment as mismanaged. A system that was regressive and unruly and even used strong arm tactics at times with audits to scare their providers. Notices for refunds from providers for services rendered in the trailing 24 months would appear by certified mail and through unjustified claim demands and then one-sided arbitration meetings would result in even more penalties and fines.  What could we do?  Why would a pediatrician with a true love of medicine and helping children need to work within such a broken system. It was heartbreaking to disconnect after many years of providing quality pediatric healthcare and the data to prove it, but that was not enough.  When you give everything professionally and personally to improve patient outcomes and then get nothing but aggravation for your diligent work, it gives you a very bitter taste in your mouth. At the same time, I have seen many of my dear colleagues anguish and languish within the current HMO Medicaid plans as their offices got financially strapped and burdened.  Office medicaid panels burgeoning and accounting for more than 50% of their patients in some circumstances. If the HMO’s truly value pediatric access and improved patient healthcare then the administrators of these plans need to get out of their offices and start negotiating face to face with any pediatricians willing to talk to them and truly “partner” in this important cause.  We as pediatricians should not and will not sit back any longer with ongoing payment hassles, delayed payments be content receiving a $35/ patient at 1/2 the reimbursement of traditional payers.  After all, for many of us, we are true gatekeepers for our little patients.  Should we provide our professional services at this 50% discount alongside our medicare (adult) colleagues? I think not!!  HMO’s, you are on notice that if you want pediatric recipients to get the well deserved medical attention and access they need, then treat us as human beings and true partners and give us that well deserved raise, one that allow us to keep our lights on in the office and give you the results of improved medical care and access for your patients.  If not, you can keep fooling yourselves into thinking that your strategy of little access or poor medical care provided in ER’s works.


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