Yeah, but when I first opened my practice and up until now, when I see 25 patients, 18 of those are Mainecare. It's an abuse of the system, but they GENERALLY don't work and given they don't have to pay anything, they bring them in. It's also because of the system since if they don't bring them in, DHHS will swoop in and take them. And, if they bring them in too much, and God forbid get B12 shots with a B12 level of 92 and a RBC diameter of 200, they call out office.
So, I must admit there are times at 5:15 when a conj called, I would ask the insurance. Now, if they are Mainecare, they will come in. Now that they pay more for WCC than Aetna and Cigna and BC/BS and they HAVE to get shots (good reimbursement), and they HAVE to come to ALL well child visits, something 35% of private insurance patients don't (or more), I stand to do better with Mainecare. Also, as stated, private pay are MUCH less likely to do shots than Mainecare. Our Mainecare rate of immunizations is about 92%. Our private is about 73%. You do the math. Four shots times the admin fee. Damn that Pentacel. Yeah for splitting up MMR-V.
And, I don't feel bad for playing the system due to being screwed for so long. Our rates for f/2 is over 80% for Mainecare and about 50% of private. Add to that that private won't even make the f/u appt.
We also are number one in the state for Pay for performance, which is not something you have to even think about; this includes the fact that I am the only pediatrician who doesn't do leads or HBs and doesn't do PAP smears. We are also number one in the state for prior authorizations to Boston and for medications, which pays nothing but makes us excited.
Being number one for Pay for performance pays me more than half of my salary, i.e. Salary + 60% of salary.
Sorry, just had to throw that in there and reveal how one can make decent money with Mainecare. It did frustrate me in the past (and now still) when I was getting 50% of private, but that is changing.
The most frustrating thing is when I was getting X amount of dollars for an ear infection while the FQHC across the street was getting three times the amount with no liability insurance, no taxes and a $650,000 stipend each year for infrastructure. And, very nice that the government is paying for Logician/Centricity for each workstation, which talking about consults, produces absolutely the worse note ever. Even their doctors come to me and ask about AC, but they can't get it.
@Leslie Talk about your medication list, they list it three times and not just "Concerta," but Concerta 36 mg Extended Release Capsules blah, blah, blah....
