Many of us have heard horror stories of people with MaineCare coverage and illnesses or injuries requiring a specialist who have had to drive long distances to find a specialist who still accepts MaineCare. How, I’ve heard it asked, can doctors be so heartless?Well, my wife’s an audiologist, and, to paraphrase bad TV, she’s not a doctor but she works for four of them at an ear, nose, and throat practice called Maxwell, Kluger & Makaretz. I can safely say that doctors are largely not heartless, but they do often have to deal with the heartless nature of this market economy we live in, just like everybody else.
When my wife came home about a year ago and said that the practice had decided to stop seeing new MaineCare patients, I knew that must have been a hard choice for them to make. On one hand, they have a powerful innate inclination to help people who come to them with everything from cleft palate to dizziness; on the other they have employees, including my wife, who do everything from manage their billing to run their balance center to fit people with hearing aids. If they see everyone who walks in the door and the percentage of patients they see who are covered by MaineCare becomes too high, the bare-minimum reimbursement (or, since the 2005 MaineCare computer disaster, the lack of any payment at all) makes it impossible to pay their employees an industry-standard wage.
Doctors have always had to manage the amount of MaineCare patients they saw. In 1996, well before the computer disasters, 19 percent of physicians reported to the Office of Data, Research and Vital Statistics that they did not accept new MaineCare patients. Calls that turned up that information from the Office of Rural Health and Primary Care and led to a number of other state and nonprofit organizations could not discover a similar statistic for a more recent year, but a number of sources said anecdotally that a combination of increasingly crippling student loans held by young doctors and the computer problems have made the practice of denying or limiting new MaineCare patients increasingly common.
Here in Cumberland County, it can be a problem finding a specialist (or a dentist, but that’s another matter entirely) difficult. In Sagadahoc County, where in 2004 there was only one doctor of any kind for every 1257 residents, a ratio four times worse than the national average, it can make finding specialists within a two-hour drive nearly impossible.
Dr. Paul Kluger sat down with me recently to discuss his decision.
What were the primary reasons you decided to stop taking new MaineCare patients?
The two main reasons we had were problems with the payment systems, which is partially due to the computer programming problems the state encountered two years ago, and the greater percentage of patients we were seeing on MaineCare, which made it extremely difficult to keep a medical practice running. Between seeing a higher percentage of patients that you’d be getting lower reimbursement [for], and then having delayed reimbursement, it wasn’t possible to keep things going.
