Brian (fellow JAMA tosser),

I've rid myself of Medicaid. I keep the Medicaid core provider agreement for the "charity slavery" the hospitals imposes on me at increasingly greater frequency. (occasionally some of these "charity" patients qualify for Medicaid which pays $20-30 per visit in the inpatient settings).

I'll have to admit, the greatest percentage of misusers and abusers happens to be Medicaid patients. Medicaid patients (generally) hold the record for most OTC meds overrides, largest medication lists, greatest no shows, greatest demands for formulary overrides, most difficulty getting referrals, dumbest middle-of-the-night phone calls, most complex billing process (not HIPPA compliant). The state often do not pay the 20 cents on the dollar and would rather spend money on useless "care management programs" and auditing the physicians. You know, even if they paid 150% of Medicare rates, I wouldn't be interested with all the hassles attached. Oh, also, the formulary for Medicaid happens to be the MOST generous when compared with the PPO market.

The only population with even a less restrictive formulary and greater privileges than Medicaid is ..... you guessed it..... the state inmates. I was medical director for our local state prison for nine years where inmates can get all the care they desire-- field trips to the dentist, specialists, hospital, etc. It's ironic that the correctional officers (state employees) are stuck with the worst access to care (state employees). Yes, if you ever need free medical care and catered meals, commit a heinous crime (must qualify for felony status rather than the slap-on-the-wrist crime).

I'll have to admit that my "cash-only" patients are generally those who have been in and out of the Medicaid experience. What I'm seeing is the extension of the byproduct that the government produces.

Anyways, I must agree with Brian. He is right on target in his assessment. That said, I HAVE HAD MORE ELVIS SIGHTINGS THAN TRUE CASH PAY PATIENTS.

Brian, we must get together to toss a few JAMAs some days. I have AAFP only for the CME purpose. But I have to rip out the CME offerings, advertisement, and ridiculous job advertisements out of the magazine before I get to the CME (LOL).