I have always believed that Medicaid was a practice builder and a social obligation. The folks at Medicaid were able to persuade me otherwise over time. In California the Medicaid program, called Medi-Cal is administered by one medical group/IPA entity for the entire county. The intent is too direct all of the patients into managed care and stop them from using the Emergency Rooms as the after hours clinic. At the same time we have "must treat" legislation that completely bypasses all of these efforts. The result is penalties for the physician whose patients use the ER inappropriately, but no penalties for the patient. In spite of all that I am not completely insensitive to the issues here. Many of these patients have desperate needs, and no transportation, especially in Los Angeles. They must wait until a family member or neighbor comes home from work in order to get a ride, and this is usually after your office hours. But none of this stopped me from seeing Medi-Cal.
Several times a year they will send inspectors to our office to do a site inspection. I am really proud of the look and layout of our office. But they are the only one that has to come and inspect our office to see if we are good enough to see their patients. A few years ago we failed the inspection because we didn't have an employee first aid kit. Normally my office manager keeps me well insulated from these delightful little interludes in an otherwise busy and productive workday, but on this occasion I happened to be standing nearby when I heard the inspector ask to see our first aid kit. The office manager said, "OK we will get one" and I said whoa, hold on a minute. This entire office is a first aid kit. Or if need be, pick any of the eight exam rooms, they are all equipped better than any first aid kit. Or if you need a kit that you can take to the patient we can go look at the crash cart again, and I will even charge the paddles for you! Nope Nope and Nope again. After some heated debate the practical solution was to spend twenty dollars and buy a little plastic first aid kit with bandaids and not much else that can be fastened on the wall so the inspectors can check a box on the form.
But even that was not enough. The "final solution" came to me when they were here again telling us what is wrong with our office. We have a refrigerator for all the vaccines and biologicals (as opposed to the specimen refrigerator or the ones for our lunches) and it has a number of things to make it safe for the vaccines. It has a number of bottles of water in the frige and bottles of ice in the freezer to hold it over in the event of a power failure and it has a number of thermometers and we keep a log and pay an employee to log the temperature every morning so that the inspectors will have some more forms to sort through when they stop in for coffee and a chat. So on our last inspection they told us we were doing a brilliant job, "BUT" they just felt we needed to log the temperature TWICE a day because the temperature might not be maintained in such a busy practice as we opened the door too often throughout the door. My response was that we did not need to record the temperature twice a day, because we no longer take Medi-Cal. It took quite a while for the inspector to get the drift, she kept insisting that I had to log this twice a day, I was equally insistent that I did not need to log it twice a day, because I no longer needed to pass her inspection.
What annoyed me the most is that the really busy practice, where the door is open so much, will surely be too busy to record the number when it is busy. They will simply fill in the logs when the Doctor is out of the office and things slow down. The presence of bureaucracy DOES NOT assure quality. Any way we are done with Medi-Cal, I have finished my RANT and I feel much better now. Thank you!!
