I am writing in response to your article reporting the results of a recent Medicaid survey performed by the Public Citizen Advocacy Group. This report describes glaring deficiencies, inefficiencies and inequities in Medicaid programs throughout the country. The report emphasizes that the care received by individuals in the program depends greatly upon where they live. Eligibility varies greatly as well, again based on geography.

The proverbial elephant in the room, however, is physician reimbursement. It is so low that every minute spent with a Medicaid patient results in negative income for the physician. It is no wonder that physicians and hospitals are reluctant to accept Medicaid patients into their practices.

Paradoxically, this forces Medicaid patients to show up in emergency rooms for care that they could be receiving in a primary setting. In addition to the greater cost per hour of emergency rooms, illnesses are often at more advanced stages and therefore require more intensive care at that point, further raising cost of care.

The report describes that in MaineCare, for example, physician reimbursement represents a mere 2.3 percent reimbursement across the board. The report also mentions that MaineCare physicians are paid approximately 53 percent of the rate of reimbursement they would otherwise receive from Medicare.

While one further considers recent humiliating adventures Mainecare has experienced with regard to its “new” computerized billing service, the solution for a significant portion of Medicaid’s problems becomes quite obvious. My suggestion is as follows:

We should scrap the idea of having 50 separate and distinct Medicaid systems with their varied eligibility requirements, quirky and difficult to understand reimbursement policies, and woefully inadequate reimbursement for physicians. Instead, why not adopt a much more efficient and cost-effective and proven system for physician reimbursement: that used by Medicare. One can only imagine the savings in administrative costs at the level of all 50 states. Reimbursement of physicians at Medicare rates opens the doors of medicine for Medicaid patients throughout the country. It is inevitable that such care would be more cost-effective than what is currently being done in emergency rooms.

This type of savings combined with administrative savings could easily cover the current shortfalls being experienced. As it stand now, millions of dollars are owed by MaineCare to hospitals throughout the state. Adopting Medicare’s fee schedule and administrative protocols would not only be more efficient, but it would provide badly needed relief to the state’s hospitals and providers.

Understandably, the federal government would be concerned about any increase in its costs. A simple approach to this is for states to be billed for their appropriate contribution.

There is no perfect solution to this crisis. We can, however, stop following protocols which make no sense.

Jonathan Herland, D.Sc., M.D., has a practice in Bangor.