The complex relationship between medical diagnosis, treatments, and insurance reimbursement has sparked discussions on the accuracy and moral implications of medical procedures. This article examines how insurance reimbursement may affect medical diagnosis and treatments, as well as the stress it might place on both patients and healthcare professionals.

Start with one example I witnessed recently when a patient was going over their physician’s report after a visit and a medical test. The patient was shocked to see a diagnosis of neurodegeneration when the patient had never been told of that diagnosis. A brief discussion with the provider disclosed that it is often the case to indicate a diagnosis for which both the patient and the provider will receive payments. But even honest mistakes in billing can have dire results for practitioners. But what is known as “upcoding” is definitely not a mistake.

And in some hospitals, this has become the MO. But action is being taken to address this practice which may result in medical fraud by utilizing non-existent medical conditions for billing. The current action is by way of a bill, temporarily named “No Upcode.”

There’s also a problem here because not every disorder may be accurately reflected in the allowable billing codes from insurance companies or the government. Neurodegeneration may be another way of describing a medical issue that is not a major medical illness—or am I wrong here? There may be thousands of medical disorders that are NOT in the codes, so what does anyone do? Yes, you look for the closest code and use it, but it may be a frightening one or one that will affect future treatment.

How will this play out if the patient needs some type of emergency care in the future and is sent to an unknown medical facility? Reviewing the records, the medical team will not have accurate details of the patient’s prior health. Additionally, when software like EPIC contains false information, such as a medication issue that never existed and appears to be unfixable, it may be of no use. I know people who have tried for years to get their EHR errors fixed, and everyone claims helplessness on the issue, including hospital IT personnel.

On behalf of a patient, I contacted the health commissioner of my state, who assured me she would look into the issue and get back to me. That was about four months ago, at the time of this writing. I haven’t heard from her, and the patient is concerned about unknown issues that may arise if I contact this woman again.

So now we’re at a standstill after six years of trying to get the hospital in question to fix the error. BTW, medical records don’t have to be maintained after seven years at which time they can be destroyed. And medical malpractice is usually limited to two years for filing a complaint, but there are state differences and there may also be “discovery” issues involved.

Anyone wishing to contact their state’s health commissioner can do so at this link.

Not limited to medical care, I have heard clinicians indicate that, when family therapy is indicated, the therapist will note that the IP (identified patient) is the mother. She, then, is saddled with diagnoses that make her the bad apple in the basket, even though it’s the family unit that is in need. Is this ethical? It seemed that didn’t matter because reimbursement was the object and it was standard practice.

For clarification, let’s go over a few details. The basis for choosing a patient’s best course of treatment is their medical diagnosis. The connection between a diagnostic and insurance reimbursement, however, might occasionally have unforeseen results. Healthcare professionals are forced to balance their attention between the clinical features of a patient’s condition and making sure the diagnosis meets the requirements for insurance coverage. This may occasionally cause the emphasis to shift from strictly clinical issues to making sure the diagnosis is “billable.” If this sounds a bit troublesome to you, we’re in the same boat.

Insurance reimbursement, therefore, has an impact on healthcare professionals’ treatment decisions. Treatments that are more likely to be reimbursed in some circumstances are given preference, sometimes overshadowing those that could be better suited or more effective for the patient’s condition. As a result, it is possible for financial concerns to unintentionally take precedence over patient care, creating concerns about the morality of medical decision-making.

Patients may experience a great deal of stress as a result of insurance reimbursement and medical care. Not knowing whether an insurance company will pay OR deny a claim for a particular diagnosis or course of treatment can cause anxiety and worry. Many patients struggle with issues like “Can I afford the recommended treatment?” and “What if my insurance doesn’t cover it?” This uncertainty may discourage patients from seeking early medical attention or pursuing necessary therapies, which could eventually be harmful to their long-term health. Harmful seems to be putting it mildly because patients may forestall treatment and die because they believe reimbursement will be (or has been) refused. How much is a life worth?

Patients without comprehensive insurance may feel more stressed because they are aware of the close connection between their financial situation and their healthcare decisions. How many healthcare facilities depend on reimbursement for care, and how do they convey this to their staff? How often have you heard that a hospital is recruiting someone because they have a very large caseload and, therefore, ensure more-than-adequate funding for that person and their staff? How much charity care is provided?

When dealing with chronic or serious medical illnesses that call for regular treatments and interventions, this stress may be very acute. Patients may also feel pressured to make health decisions that are in line with what their insurance will pay for, perhaps compromising the best possible care in the process.

Patients may have significant administrative burdens while navigating insurance policies, coverage restrictions, and claim denials. Claims denials, too, are a hot topic since we know that some companies are using AI for denying claims. It reminds me of a physician who was making decisions on Social Security Disability benefits. Most clinicians take at least one-half hour per claim, but this man claimed he did 600 in an hour and was making an extraordinary amount of money doing it. Who was checking on the denials he was, most probably, making automatic denials?

Having trouble comprehending insurance terminology and being concerned about unforeseen out-of-pocket costs can cause frustration and bewilderment. As a result, patients may spend significant time and effort attempting to understand insurance-related issues, which would otherwise be focused on their own health.

Medical diagnoses, treatment choices, and insurance reimbursement are intricately linked, with significant ramifications for patient care and healthcare delivery. Recognizing insurance reimbursement’s possible effects on patient well-being and healthcare professional stress is critical because it helps keep the healthcare business alive.

Stakeholders can work toward a more harmonious strategy that emphasizes accurate diagnoses, efficient treatments, and overall patient health by acknowledging the ethical problems presented by this connection and promoting patient-centered care.

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Significant change is needed. But what change? Lowering drug costs will not lower total spending on health so long as pharmacy benefit managers (PBMs) continue to profit from the “spread.” Access to care will not improve so long as we ponder the future of essential telehealth services. Patient adherence will not be supported if formularies can call upon “non-medical switching” as a go-to negotiating tool. The US percentage of GDP will not align with other developed nations’ investments in health if we don’t redirect effort to emotional and physical preventive and value-based care. Fixing one piece of the healthcare puzzle is helpful – but is it transformational?

There are changes afoot that we need to make happen sooner rather than later by moving minds, systems and behaviors so that life-sustaining and life-saving approaches to patient care may eventually tip the scale of human survival toward health and wellness. However, we see data through the lens of a human perspective – sometimes self-interests or emotional needs for control.

Here are 10 possibilities that are not dreams – they can happen – if the health ecosystem leaders think beyond cost, reimbursement or authoritative voice and focus on people’s healthy longevity:

1. Artificial Intelligence (AI) — A future of engagement and collaboration:

AI has been around since the Gutenberg Bible! In 1899, medicine made a giant leap into AI by publishing the Merck Manual — a handbook that collected all known medical advice and gave physicians a compendium of diagnoses and treatments. No expert can remember the vast canon of medical information within their specialty, and books became a source of “augmented knowledge.”

Too many health systems and physicians view AI as “novel.” Addressing the obstacles to implementation within their health systems is critical to enhanced decision-making benefits offered by AI. Concerns about cybersecurity and training are valid! However, the value of implementing artificial intelligence is not about embracing technology — it’s about amplifying human wisdom to address patient urgencies effectively.

Human intelligence can be augmented by uniting data, patient files and other health professionals’ patient-care experiences, channeled through this technology platform. We must now rally to address questions about data quality, emotional resistance to change and cybersecurity. As innovation theorist, John Nosta writes about the emerging importance of aligning IQ and EQ with TQ (technology quotient).

“The battle of man versus machine might be ending where cooperative engagement provides transformative solutions to a wide variety of problems and opportunities.”

2. Behavioral Health — America does not lack a supply chain to manufacture chronically ill citizens:

We are killing ourselves slowly…with poor nutrition. We continue to add belt notches to our waistlines. The added weight also increases risks for heart disease, diabetes, cancer, mental health stressors, and more. Who pays those sickness bills? Employers foot a large percentage of the nation’s workforce health insurance. It’s time to look beyond providing an expected workplace benefit. Physicians, employers, payers and the people they seek to help must reduce the waistlines of people tipping toward the obesity border! Helping consumers shed unnecessary pounds and meeting their corresponding medical priorities offers immediate life-saving and personalized health benefits.

The best option for corporations footing a large part of the health bill is to intervene with payers and recognize benign neglect in tackling the obesity epidemic only adds to suffering and expense. Louis J. Aronne, M.D., who founded the breakthrough patient-centered health-tech Intellihealth along with Weill Cornell Medicine physician colleague Katherine Saunders, MD, notes:

“Obesity is a very complex chronic disease with a number of causes from diet to underlying medical conditions, medications and genetics. “Through our extensive research and applied medical model, we have incorporated all of our practice methodologies into a single software platform, which delivers a blueprint for treating obesity with supervision and continued oversight. Evaluation of our approach demonstrates 3x the number of patients reaching the key outcome measure of 5% or greater weight loss compared to programs that incorporate behavioral interventions alone.”

3. Decentralized Clinical Trials — Democratize drug development:

Even before COVID-19 appeared, traditional clinical trial recruitment models were being reconsidered. Drug development was almost sidelined during the pandemic, and clinical research organizations (CROs) recognized that they needed to reinvent patient recruitment. Operation Warp Speed showed how to put the pedal to the metal for COVID-19 vaccines; systems developed now can be applied to other high-priority, clinical urgencies such as treatments for rare diseases and often-fatal cancers.

Collaboration to advance the process is working. Science and research pioneers such as Amir Kalali, MD, and Craig Lipset, who co-lead the industry-wide DTRA.org group, show the sector’s readiness to change direction collectively. Innovators like Michelle Longmire, MD, CEO of Medable, and Irfan Khan, MD, CEO of Circuit Clinical, demonstrate that an industry known to advance new medications from bench to bedside can innovate how and where patients are invited to participate in urgently needed therapeutic discoveries. Innovation is based on finding new paths to address unmet needs.

To accelerate drug discovery and development possibilities, biopharma and medical device companies need to find a new set of allies – patient advocacy organizations and their communities; primary care centers with access to people in rural and inner-city communities. They must recognize that in working with government, sector companies, and those that seek to serve – people with health needs – they can go farther, faster.

4. Digital Health — Physicians and patients need coverage clarity:

Food and Drug Administration approval for life-sustaining innovations does not necessarily sway payer access decisions. “Claim denied” is the all-to-often refrain when physicians and their patients seek access to a 510 K-approved medical device or digital therapeutic.

Payers may have sufficient justification to deny coverage. But what are the criteria for those “dead-on-arrival” reimbursement decisions? What are the guidelines to secure formulary approval? If more data are needed to ensure access for patients — insurance customers — payers must become partners in the sector’s and patient-care success. Adding bricks to the walls patients must circumvent to secure care for themselves and their families does little to improve care or customer relationships.

Digital health analyst and author Artur Olesch outlines a challenge for the coming year in a question many more should be asking:

The COVID-19 pandemic has accelerated the implementation of telecare and telemedicine. Individuals are increasingly using mobile health apps. What can be done not to waste this potential?

5. Ecohealth — We need a healthy planet or else:

Where you live impacts how long and how well you live. Thousands of U.S. communities are ticking time bombs. The harsh reality is that 26% of Black Americans and 29% of Hispanic Americans live within three miles of a toxic landfill site, exposing these communities of color to dangerous levels of lead and other heavy metals and chemicals. We must face the harsh reality that while planet earth can do just fine without humanity; humanity needs a healthy planet. This was the striking call-to-action by Meharry Medical College President and CEO Dr. James E.K. Hildreth.

The longer we wait, the harder it will be to course-correct. The shift to a healthier world requires other innovative superpowers — courage and collaboration. According to Bob Martineau, senior partner FINN Partners, a former Federal and State government official focusing on environment issues: 

Though we breathe, eat and live in the environment, we often forget just how interconnected all aspects of our health are with the world around us. Exposure to dangerous levels of air, soil and groundwater pollution is proven to cause a cascade of life-threatening woes that include cancers, nervous system disorders, respiratory diseases, and premature births.

6. Tackle older patients’ care and adherence challenges:

When people are diagnosed with a chronic or severe medical condition, we must ensure that the patient-physician relationship guides care and that the medical ecosystem prioritizes medication adherence. The National Health Institute reports that 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. We don’t need to invent or create new care challenges. Let physicians already seeking to do good oversee clinical-care decisions.

Age discrimination and comfort with using technology to access the health system are barriers to access and understanding medication use and adherence. Age bias is often attached to health conditions often experienced in older persons. While older Americans often are the health system’s most significant customers, they face continued discrimination. We must see continued innovation in earlier detection of illnesses that impact seniors, such as loneliness, Alzheimer’s and even sexually transmitted diseases.

7. Health disparities — The most vulnerable need access to care now:

Decades of racism place people of color in harm’s way from COVID-19 more than any other community. Blacks are dying at a rate of 50.3 per 100,000 people, compared with 20.7 for whites. In New York City, the most densely populated place in America, 19% of residents, many people of color, live in poverty, while 17% live in overcrowded conditions. We seem unable to come to grips with the reality that health disparities cause multiple public health disasters and cost lives and dollars.

We must reach the communities that seek information in ways that speak to their interests and needs. What groups such as Hip Hop Public Health creatively use the power of music with health-specific messages to mobilize and change mindsets.

America is among the few developed nations that deny good healthcare services to those most in need. Neglect and racism are morally counter to the health mission of medical leaders. The changes of senior citizens to access health networks easily must be addressed. Policymakers, corporate leaders and citizens must raise their voices to enact change. A cultural shift is needed to rally communities for awareness and education. According to Yele Aluko, MD, MBA, chief medical officer at EY:

The current conversation going on nationally about societal justice, about health equity, drives a moral imperative. This conversation is going on across health systems, big business, government, and philanthropic organizations. Everybody’s talking about how we need to fix this wrong, so the time is now. We have a convergence of goodwill that drives my optimism. But we must seize the moment and translate it into actionable solutions.

8. Metaverse — Smart technologies channel our imagination toward curative possibilities:

Do you have an imagination? Put it to work to heal. After all, medical engineering is a pioneering effort that connects people’s ideas with human biology to overcome sickness. We entered the “Matrix” the first time we imaged a therapeutic stent, LVAD and 3D-printed artificial limb; complex operations became possible when expert hands drew upon technology to realize new concepts.

Rafael Grossman, MD, FACS, has been tapping technology to improve patient-centered medical care. Always ready to explore the disruptive power of technology in medicine, Dr. Grossman has been at the forefront of using smart glasses, augmented, virtual and mixed reality to change the way we practice and teach medicine.

Grossman and medical compatriots such as Daniel Kraft, MD, don’t see the metaverse as sci-fi. Artificial reality, virtual reality and wearables are used by leading-edge practitioners to advance patient outcomes.

9. Remote Patient Monitoring and Telehealth — Remote care after COVID-19:

Digital systems are built into beds, furniture and watches. Medical wearables make hospital stays more customer-friendly by delivering patient information straight to providers’ smartphones and central monitoring stations. At the height of the pandemic, there was a dramatic uptick in telehealth and remote care. As reimbursement rates shift, patients worry they will lose the benefits of remote care.

Ever so often, Congress, the Centers for Medicare and Medicaid Services and private payers pump the brakes on continued remote access with life-saving services such as telemedicine. We need to change the culture of conservatism when it comes to remote advancements and access. Groups like the American Telemedicine Association are essential voices for access and a sensible hybrid approach to care.

Medicine is a culture where patients are not yet seen as customers. Cancer survivor, caregiver and health professional Stacy Hurt, a HIMSS Digital Health Influencer and recent participant in a VyTrac-sponsored webinar on remote patient monitoring, writes on the importance of a hybrid approach:

Patients ultimately want two things: hope and options. We’re finally to a point where telemedicine is an option. It for sure shouldn’t replace the in-person encounter and relationship between the healthcare provider and patient, but it is an option we need to preserve.

10. Self-Care — Our health system keeps us alive — it doesn’t keep us well:

Our health system is not built around sustaining “health.” We have invested mightily in national illness management, a sick-care structure that offers no return on investment regarding a better path to healthy longevity. Value-based and preventive care to keep the illness at bay is a big win-win-win for households, companies and governments that now foot the nation’s health insurance bill. Employers and payers will find that incentivizing self-care and illness prevention is a more innovative business model.

WebMD Chief Medical Officer John Whyte, MD, an author on bestsellers with life-saving tips to reduce cancer and diabetes risks, writes:

The biggest myth has been that (cancer) is primarily caused by genetics or just bad luck and there is nothing that you can do about it. The reality is only about 30% of cancer is caused by what we would say are inherited mutations or family history. The rest is primarily influenced by lifestyle. I know, although nothing is 100% preventable, we have learned through science that you can reduce your risk by deciding what you eat, how much you exercise, your level of stress, the quality of your sleep. These are all things you have control over.

If this roster of innovations in hand tells us anything, it’s time we put health-system mindset change front and center. There are plenty of great reasons to say, “this won’t work” or “let’s not do it; it adds to costs.” It is understandable that new products, services and approaches take time to implement and cost money. But when we look at people’s well-being, adding complexity to people’s lives that separates them from access to the best quality of care has never been medicine’s intended mission.

We look to changes such as Amazon purchasing One Medical as a pathway to fix that which is broken. We have an abundance of innovative, readily and inexpensive (often generic) medicines. We often can speak with a skilled health professional through our smartphones and tablets. Perhaps the change so sorely needed isn’t another billion-dollar acquisition and “roll-up,” it’s addressing the challenges of collaboration and transparency?

Health providers are at the forefront of confronting our significant societal challenges. They have risen to the task heroically. Health disparities between the haves and have-nots and developed and developing nations have opened our eyes and hearts. Innovation combined with our determination must open the door to fundamental system change.

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Most of us assume that discharge is up to our treating physician or surgeon to decide when it’s appropriate for us to go home and what sort of in-home treatment or rehab we should have prescribed as part of our aftercare. We are, in that regard, totally in the dark because the day of discharge has been taken out of your physician’s hands and is controlled by a codebook; the DRGs are an all-payer guide with one section, another, the MS-DRGs, for Medicare patients.

What is this mysterious acronym? The acronym stands for Diagnosis Related Groups, a plan for codes for illnesses and procedures related to them. These codes (there are 740) are mandates for discharge, and physicians must abide by them unless there are extenuating medical circumstances.

Ask the older women in your family how long they remained in hospital after the birth of their children. Today, women may remain for one day or 48 hours. Previously, women may have been patients in the hospital for up to 10 days after childbirth. The DRGs changed all of that.

Specialized medical practices such as those for reproductive medicine have begun providing professional articles to assist physicians in coding and reimbursement. Patients who may wish to peruse the reimbursement rates for orthopedic procedures can find this information here. But note that there is no agreement among hospitals that would indicate they all bill at the same rate. Essentially, the patient is on their own when it comes to cost because of a lack of transparency.

The DRGs aren’t something new because the codes were designed and implemented as part of the prospective payment system for Medicare in 1983. How effective has it been at attaining its primary goal, and have there been problems with its design and utilization over the years? Psychiatrists began expressing their displeasure almost as soon as they saw the coding in 1986.

These issues include the problems of premature discharge, code manipulation, cost-shifting, and equitable patient access to psychiatric services. The potential effects of a DRG payment system on clinical practice are reviewed.

The psychiatrist’s view was relevant to the DRG and its application to psychiatric intervention. Based on limited data on the issue of discharge of psychiatric patients, it was believed that this information was not developed, tested, or applied in psychiatric facilities.

In fact, of the 14 psychiatric diagnostic groupings contained in the initial DRG listing, none were validated in any psychiatric facility, whether in a general hospital, a general hospital’s psychiatric unit, or a private psychiatric facility.

How could anyone, with such flawed data, decide when the discharge of a patient with a psychiatric disorder was appropriate? Considering that the listings were to optimize savings in terms of reimbursement, inappropriately released psychiatric patients would become a burden on local communities, and it was reasonable to assume they would be rehospitalized, potentially at a higher rate. Liaison psychiatry, found to be a cost-effective means of providing care, was not factored into the DRGs.

Another problematic aspect of this coding system is that it’s not uniform in its application for Medicare, Medicaid, and other third-party payment for hospitalization. Code manipulation is present in every form of care under the DRGs.

One aspect of code manipulation (at whose benefit?) is billing practices for reimbursement for patients with multiple disorders. The patient is treated and discharged under one DRG mandate and then re-admitted under another of their illnesses and treated again until that DRG mandate kicks in. Ethical, patient-friendly, or beneficial to the facility’s bottom line? Physicians in one study found this was used particularly with geriatric patients.

Another practice with psychiatric patients is DRG-creep, where a patient is diagnosed with a disorder that pays at a higher rate. When a diagnosis is restricted to a psychiatrist’s independent opinion, who can question this?

Consider another aspect of hospital discharge following DRG guidelines. Where does it indicate any provision for family care, appropriate follow-up services, or placement? If there’s no place for the patient to reside, what do you do, admit them to a rehab facility where another set of DRGs will be initiated? Is this cost-saving for whichever agency is paying for care?

The previous paragraph brought to mind two cases of lengthy hospitalizations. One was for a young woman, about 18, who had been an inpatient in a private psychiatric hospital for five years. I asked what her diagnosis was on discharge. The social worker said, “We’re meeting to decide that today.” That day? What were they using as her diagnosis for all those years? Of course, her wealthy family had private insurance, but didn’t the insurance company demand a working diagnosis? Was it DRG-creep here?

Another is a bizarre case that resulted in active media coverage and a book. It was about the life and hospitalization of Huguette Clark. Fabulously wealthy, she was a patient in a major New York City hospital for 20 years. No DRGs there?

Medical care is still ruled by reimbursement, and the DRGs hold an untenable place in that hierarchy.

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“Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. Individuals with a behavioral health disorder also utilize significant health care services — nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved individuals with a mental disorder, substance abuse problem, or both.”

Eighty-two million-plus people are served by Medicaid each year. If the need is so great, and it is admittedly the case, what is the reason reimbursement rates for Medicaid patients are so low? Don’t low-income individuals or families deserve to be on equal footing in terms of any healthcare with other families who live above the poverty line? States determine who is eligible for the program, and it can be quite wide-ranging and daunting for any individual to figure out what services they have available to them.

What are the current rates in a state like New York or New Jersey for Medicaid reimbursement for mental health services? Figuring out the payments and co-pay isn’t for the faint of heart. As usual, it’s convoluted and requires billing experience, and that’s the reason that career may receive a bump in persons needed.

Medicare pays covered providers about $77.81 for 30 minutes of individual therapy. Not everyone will use that 90832 code. Higher billing rates are a prime issue here and . billing is left to ethical and legal issues. But Medicaid, for the same session, could pay less than $60.

In some cases, previously, the rate was about $50. When many psychotherapists are charging over $100/hr (and in NYC it could be $300/hr.), who is going to accept a Medicaid patient? Therapists have a right not to accept patients and some will do so if the individual doesn’t have “adequate” reimbursement.

It is a disturbing fact of life that, when potential patients call for a therapy appointment, they will often indicate they have insurance coverage. How demeaning for them. The bottom line is that money can be a major issue for care. One woman, who indicated she believed every therapist was qualified, wrote a book on her experiences.

I heard of a case where a therapist, in a large practice run by a psychiatrist, was in a session with a Medicaid patient when the door suddenly burst open. The psychiatrist told the patient to get out and never come back again.

It was an unwritten rule in the practice that Medicaid patients would not receive services. The therapist, not knowing of this practice, had agreed to see the patient, a young man with HIV and prior drug addiction.

One of the major problems that lead to quality differences must be considered. Anyone who has a thriving practice and sees a few pro bono cases, may not accept Medicaid cases. Who will accept them? Money is a great temptation and knavery waits for its opportunity.

Although we do hear of occasional whistleblowers reporting unethical and fraudulent Medicaid cases, many who receive the care either don’t realize the care is by unqualified persons or would be reluctant to report. Just as there are pill mills, there are Medicaid/Medicare mills run by unscrupulous therapists who reap the profits and care little about anything other than filling appointments.

Some practices book patients for multiple sessions, one after the other, for additional therapy during one day with other therapists. Ever notice those “hot boxes” outside the doorways to offices?

I also heard of a master’s-level licensed therapist who accepted Medicaid and provided therapy for children who were sexually abused. After more than four years of therapy with one boy, the therapist, when questioned, admitted that he had not received any advanced training. Where was management in this case? He works at a local mental health center.

The boy was not making progress in this therapy, but the mother felt she had no recourse to obtain therapy with someone else. Everyone she called refused services once she indicated it was a Medicaid case.

But it’s not only in psychotherapy that the lower-income patients receive care from an unlicensed, neophyte, or inadequately trained individuals. A highly experienced ENT physician admitted to me that he was no longer doing surgery because “I get about $3 for an operation that costs $1,500,” he said. I think he was engaging in hyperbole because I’m sure Medicaid pays more than that for ENT surgeries.

How Medicaid can be made more equitable in terms of reimbursement is a question for everyone, but especially the politicians in each state. Services to anyone must be done on need, not payments, but that’s where it stands now. As they say, money talks. Does your state offer charity care for those in need?

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