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Commentary: Doctors Should Consider Committing to a Practice of at Least 5 Percent Medicaid Patients

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Doctors should consider making a commitment to accepting at least some Medicaid patients, argues a Weill Cornell Medical College physician - enough so that at least 5 percent of their practice is Medicaid. For most primary care physicians, the commitment would mean providing care for about one Medicaid patient a day. For most surgeons, it would mean one Medicaid surgical case every week or two.

Dr. Lawrence P. Casalino, chief of the Division of Outcomes and Effectiveness Research and the Livingston Farrand Professor of Public Health in the Department of Public Health

Such a commitment would not only better Medicaid recipients' health by reducing their wait times to receive care, but would lessen the time doctors spend searching for specialists to accept these patients, writes Dr. Lawrence Casalino in a commentary in this week's New England Journal of Medicine. The "5 percent commitment" also would pressure policymakers to increase physician payments by creating a critical mass of doctors invested in the program, and reduce the time doctors spend obtaining authorization for care, diagnostic procedures and medications, he says.

"There is a fundamental reason why physicians should strongly consider providing care for at least a reasonable number of Medicaid patients," writes Dr. Casalino, chief of the Division of Outcomes and Effectiveness Research and the Livingston Farrand Professor of Public Health. "It is a core professional principle that physicians should put the patient's interest first; refusing to care for vulnerable, socioeconomically disadvantaged Medicaid patients seems incompatible with this principle."

In the commentary, Dr. Casalino suggests that professional societies promote the 5 percent commitment to include Medicaid recipients in physician practices. Some 30 percent of office-based doctors don't take on new Medicaid patients, with refusal rates climbing to 56 percent in specialties such as psychiatry. The American Board of Internal Medicine Foundation and multiple specialty societies already are urging physicians to "choose wisely" in their prescribing of tests and treatments to decrease health care costs, Dr. Casalino notes - a model for a similar, voluntary commitment around Medicaid. Some 73 million Americans are covered by Medicaid - a number expected to increase with the implementation of the Affordable Care Act.

"If all physicians cared for Medicaid patients, all would have a reason to care about the Medicaid program, so that more pressure could be brought to bear on the program to provide reasonable payment rates and reduce administrative burdens," Dr. Casalino writes.

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