ED physicians may be left out as HMOs pass on Medicaid managed care
Augusta, ME-Medicaid officials are trying to convert the state's fee-for-service Medicaid program to one operated under a managed care arrangement, but commercial health maintenance organizations (HMOs) are passing on the idea.
State officials believe the HMOs are resisting due to the relative inexperience of Medicaid administrators with managed care contracting, but others believe the number of patients who would enroll in such plans is too small to make the venture worthwhile for HMOs. About 8% of Maine residents are presently enrolled in Medicaid.
Meanwhile, emergency physicians are watching developments closely out of concerns that reimbursements may drop significantly under the Maine proposal.
The poor response from HMOs has left state officials with no choice but to contract directly with providers via physician hospital organizations (PHOs). These are managed care organizations in which hospitals and physician groups band together and contract for services, much in the way licensed HMOs do business.
In most states, emergency physicians contract directly with hospitals and usually have little say in MCOs. Some analysts believe emergency providers may have to deal with PHO boards now or be forced to accept payment rates that are negotiated for them by the PHOs.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content