According to the American Medical News, Florida physicians are struggling with the burdens of bureaucracy as they try to work with a new Medicaid pilot. Similar to the issues of the "medical home" pilot I have written about before, the people who create these new programs tend to always forget who the customer really is. In this example, a five-year pilot Medicaid reform in Florida designed to improve care access and quality has not yet lived up to its expectations and has some physicians considering dropping out of the program rather than dealing with its new hassles. Those hassles include restricted drug formularies, confusion about which actual plan the patient is on, and specialist access. What the administrators of this genius plan don't understand is that the doctors ARE the customers! I know that sounds pompous and not the politically correct thing to say but, sorry, it's the truth. Medicaid pays so little as it is that the people in charge need to make any pilot as battle tested and streamlined as possible. There has been pilot after pilot out there that has failed due to new states trying to reinvent the wheel. And by the way, no matter what new "pilot" is ushered in there has to be a plan in place to sell it to the customers; that being the physicians. If they fail in doing that then you don't have anyone who wants to see these patients even if you give them a better plan. Oh yeah, you also might want to find a way to get more primary care doctors into the system as well. Are you listening President-elect Obama?