I found a blue baby two weeks ago

[Pea-n-Me]

Turned out he had situs invertus totalis with dextrocardia, along with tetrology of Fallot. He had surgery the next day.

I would think this baby's physical exam would have warranted an early echocardiogram. Glad this mother found her way to you.

 

[DawnCt1]

I think that you mean "Medicaid" and not "Medicare" Either way, it sounds very wrong, though.

No, I mean Medicaid with regard to the child with an infection. I mean Medicare with regard to my cousin who is 72, lives half of the year in Florida and the other half here in Ct. Physicians can decide that they will not take ANY Medicare patients, and someone, such a a gyn physician who primarily deals with the "younger, not collecting social security" set, can do that and still having a thriving practice. If they make the decision not to accept anyone on Medicare, then they have to be consistant and not even make an exception.
Back to the child with the infection. DH was angry with the physician because she indicated to him that she would treat the child and never asked what the financial arrangements were.

 

[stm61]

this is nothing new with dr's refusing to treat medicaid patients. My ds12 was born before the new insurance laws regarding pregnancy not being a pre-existing condition and portability of insurance. Due to a job change while pregnant, the only coverage I could get for him was medicaid. At the time we lived in upstate SC. I could not find a pediatrician in 2 counties that would accept new medicaid patients! The only thing available was a night clinic that was first-come, first served. We literally spent hours there every time he got sick and the care was less then great. I eventually was able to cover ds under private insurance, but my foster kid's all came with a medicaid card. The social worker's would have to twist dr's arms to get the kid's seen! I totally understand why many people use the ER as their family dr, they really have no choice!

 

[Kaycee]

remember that the baby might not have had the oxygenation symptom until the PDA closed and that can take a few days sometimes, so perhaps the baby was pink while in the hosp.

That was the first thing I thought. This is why follow-up with newborns is so important. Good catch on your part. I'm glad to hear the baby is doing fine now.

 

[chrissyk]

No, I mean Medicaid with regard to the child with an infection. I mean Medicare with regard to my cousin who is 72, lives half of the year in Florida and the other half here in Ct. Physicians can decide that they will not take ANY Medicare patients, and someone, such a a gyn physician who primarily deals with the "younger, not collecting social security" set, can do that and still having a thriving practice. If they make the decision not to accept anyone on Medicare, then they have to be consistant and not even make an exception.
Back to the child with the infection. DH was angry with the physician because she indicated to him that she would treat the child and never asked what the financial arrangements were.

Wow, I'd never heard that Dr.s can make a decision not to accept anyone on Medicare...Medicaid yes, but not Medicare. That is really strange. Is it just a matter of these Dr.s not wanting to deal with the govt. beaurocracy when it comes to getting reimbursed, or do they not want to deal with old people or what

 

[Pin Wizard]

Prayers for that little one! Hope improvement continues. Wouldn't you just love to send that report to the *(&Y*&%*&) heartless doc?!

I was a blue baby when I was born. Baptized in the hospital the night I was born. Can just imagine how that scared my parents.

 

[laurie31]

Wow, I'd never heard that Dr.s can make a decision not to accept anyone on Medicare...Medicaid yes, but not Medicare. That is really strange. Is it just a matter of these Dr.s not wanting to deal with the govt. beaurocracy when it comes to getting reimbursed, or do they not want to deal with old people or what

Medicare and Medicaid do not reimburse very well. And yeah, the paperwork is a huge PIA. On the one hand, doctors should not be (and most ARE not) in it for the money, but they do have to make a living, pay their staff, pay huge malpractice insurance premiums, etc. I may be wrong on the percentage, but I think medicaid only pays 60% of what other insurance will pay. The doc has to "eat" the rest. Patients with private insurance have to unofficially subsidize the medicaid ones. I don't know how much medicare pays but it's not the full amount. Very sad. Especially for the patient.

Back to the OP, Yes, do send the ped one of those courtesy consult letters, "thank you for allowing me to participate in the care of this patient, blah blah blah" and the discharge summary. Heh.

And here's a fairly English explanation of Tetralogy of Fallot:
from http://www.med.umich.edu/1libr/chheart/care04.htm

What is Tetralogy of Fallot?

Tetralogy of Fallot is a type of heart problem which consists of four different heart defects.

The first defect is called a ventricular septal defect (VSD). This is a hole between the two bottom chambers (ventricles) of the heart.
The second defect is called Pulmonary Stenosis. This is a narrowing at or just below the pulmonary valve.
The third part of Tetralogy of Fallot involves the aorta being positioned over the ventricular septal defect instead of in the left ventricle.
Finally, the right ventricle in infants born with Tetralogy of Fallot is more muscular than normal.

and this link has pictures

http://www.americanheart.org/presenter.jhtml?identifier=11071

Laurie

 

[bear74]

It was about the scariest experiences I have had in my entire life. It was the first time I had ever seen the mom or the baby--he was three weeks old at the time. Mom was more concerned about some "spit dermatitis" he had around his mouth and that he had a "cold" (ie, couldn't eat because he couldn't breath because he was not getting any oxygen to his organs). He was gray at rest, and turned the color of a storm cloud when he cried. I cut the exam short, and got on the phone to the cardiologist at the Children's hospital as soon as I could. Turned out he had situs invertus totalis with dextrocardia, along with tetrology of Fallot. He had surgery the next day.

I haven't yet told the pediatrician (yes, board certified pediatrician) who saw him in the hospital, sent him home to follow up with lowly me, a family doctor about his "heart murmur". I should say so. Actually, mom told me that the pediatrician refused to see him the day before I did, because the baby had medicaid. Wow. Amazing. Maybe I should just send the other doc the discharge summary. The baby is doing well, and was released from the Children's hospital Monday this week.

Oh my goodness! That is scarey. I work on a mother/baby floor at my hospital. I have found only one gray babyin my 7 years working. I'm suprised the pedi at the hospital didnt order BP of all 4 extremities and an echo.
Almost all of our pedis order these especially if the murmur is still there on day of discharge.
Good catch on your part.
Was the pedi who saw the baby in the Hospital a neonatologist. We Have a pedi who works closely with our neonatoligist on staff who sees all the baby's that dont have a pedi chosen yet. They then have to follw up in 2 days from Discharge. If the pedi saw the baby in the hospital that pedi new it was medicaid and should have told the mom then that he could not see her baby. IF they do not take medicaid then he would not get paid for seeing that baby in the hospital.

 

[DawnCt1]

Medicare and Medicaid do not reimburse very well. And yeah, the paperwork is a huge PIA. On the one hand, doctors should not be (and most ARE not) in it for the money, but they do have to make a living, pay their staff, pay huge malpractice insurance premiums, etc. I may be wrong on the percentage, but I think medicaid only pays 60% of what other insurance will pay. The doc has to "eat" the rest. Patients with private insurance have to unofficially subsidize the medicaid ones. I don't know how much medicare pays but it's not the full amount. Very sad. Especially for the patient.

Medicare reimburses at a low rate but many of the elderly also have supplemental private insurance, however, some do not and often the physicians can't bill for the residual. I would guess that the exhorbitantly high rate of malpractice insurance that OBS/GYN. are required to pay make taking Medicare patients an even "greater losing proposition". I know many internists find that medicare doesn't cover the cost of seeing the patient and billing in many cases.

 

[MrsToad]

To follow up on what DawnCt1 noted about seniors and OB/GYNs, my mom just told me of a letter she received from her GYN this week. The letter noted something along the lines of "we see you are turning 65 in May '06 and will be covered by Medicare. We no longer accept Medicare patients so if you wish to continue with our practice, you will be responsible for the full charges for your visits." My mother has been with this practice for years and years but is on a fixed income. Though I understand the delimma faced by physicians concerning the low reimbursement by Medicare and Medicaid, it has begun to feel like the dollars matter more than the patients.

On another note, hope that you are never a Medicaid patient needing dental care in CT. One of my sisters is disabled and covered by Medicaid. She had an infected absessed tooth in November. The community health agency told her she needed an oral surgeon immediately. The only one in her area who accepted Medicaid wouldn't schedule her, even thought this was an emergency, until MARCH! Even the remaining option, a hospital having a dental department which accepted Medicaid, wouldn't see her until March. What are people supposed to do??? Even though the Dr. had given her antibiotics for 10 days, how can you let such a condition wait for 4 months?!

 

[laurie31]

Not to hijack the thread, but this is why socialized medicine won't work in this country

Laurie

 

[chrissyk]

Not to hijack the thread, but this is why socialized medicine won't work in this country

Laurie

I agree with you. Even countries with socialized medicine seem to have alternative private-pay insurance plans that get people better service/appointments. The haves would end up buying those supplimental plans and the have nots would be waiting 4 months to get their absessed tooth taken care of IMHO.

 

[DawnCt1]

To follow up on what DawnCt1 noted about seniors and OB/GYNs, my mom just told me of a letter she received from her GYN this week. The letter noted something along the lines of "we see you are turning 65 in May '06 and will be covered by Medicare. We no longer accept Medicare patients so if you wish to continue with our practice, you will be responsible for the full charges for your visits." My mother has been with this practice for years and years but is on a fixed income. Though I understand the delimma faced by physicians concerning the low reimbursement by Medicare and Medicaid, it has begun to feel like the dollars matter more than the patients.

!

Most physicians are lucky to break even on Medicare. If you are an OBS/GYN physician however, a Medicare patient could represent a loss. Most GYNs who deliver babies are paying in excess of $250K in malpractice per year, depending upon the state. Ct is a state that has high rates.

 

[delilah]

One of my pet peeves is doctors who don't take medicaid patients. For example, in our office, we have 3 of 7 doctors who take very little medicaid, and when a patient that is assigned to them comes into the office, they either refuse to allow the patient to schedule or foist the patient on the rest of us. One doctor galls me in particular, because she refused to see a particular patient after she got medicaid, even though previously, when the patient had insurance, the doctor had seen this patient FOR YEARS. As a consequence, we work much harder and get less money. (Medicaid patients are usually much sicker and have many more problems than insured patients do). The justification is that we are employed by the hospital. I just know I get tired of the princess attitude, and would walk out if I had a better place to go.

 

[DawnCt1]

One of my pet peeves is doctors who don't take medicaid patients. For example, in our office, we have 3 of 7 doctors who take very little medicaid, and when a patient that is assigned to them comes into the office, they either refuse to allow the patient to schedule or foist the patient on the rest of us. One doctor galls me in particular, because she refused to see a particular patient after she got medicaid, even though previously, when the patient had insurance, the doctor had seen this patient FOR YEARS. As a consequence, we work much harder and get less money. (Medicaid patients are usually much sicker and have many more problems than insured patients do). The justification is that we are employed by the hospital. I just know I get tired of the princess attitude, and would walk out if I had a better place to go.

It seems to me that if the practice takes Medicaid patients, the responsibility should be shared. They should not be foisted off to others in the practice. Of course if the "refusees" are partners and you are still in the category of "employee", it probably makes having a staff meeting to discuss it, worthless.
But you are right. They tend to be sicker and require more time. If you are all employed by the hospital however, can they make that decision unilaterally?

 

[delilah]

I am not employed by the practice, but, by the hospital. I have 15 years seniority in the practice, the other two employed physicians have 10 years seniority. The three who are "self-employed" include the most senior member, who has been there 24 years, and one who has been there 5 years and one who has been there two. I don't consider the Newbies to be my "boss' in any meaningful sense of the word. The most senior member wants to be self-employed--good for him, I say. The other two have really been unable to negotiate with the hospital--they aren't hiring more family practice docs at this time, since, in my opinion, family practice is over-staffed at this time.