Re: Re: jumping off one hamster wheel

[Guest guest]

Larry and Chad and all,

I (obviously) agree with both of you. I do not know if any one high up in the government " gets it. " I agree that the administrative burden is now falling on many of my patients, but I also see this awareness as the only way to start fueling reform of the administrative minutia forced on all of us by the insurance companies.

I had a potential patient call and, after my receptionist, Josie, explained that I do not contract with any insurance companies, she proceeded to try and educate Josie " that it would behove Dr. to hire someone to do the filing of claims. " If I had been on the phone, I would have said I was " already " behoovened " --been there, done that. "

I had thought about offering my husband's services to those who did not want to mess with filing their own claims. Then they would pay me in full at the time of service, and, for a fee, Steve would file their claim and, for another fee (depending on the time on hold, the number of refilings, and the cost in providing " additional information " ), he would do a bit of fighting on their behalf for them to get reimbursed. It would then be my patients " hiring " someone to file their claims and they could decide if the extra cost was worth it.

I feel very strongly that the administrative burden of fighting insurance companies is not part of providing excellent health care. Filing of claims and fighting with insurers is not something that is, or should ever be, taught in medical school. Physician's only entered into this silly arena when they were competing for patients, and this was an added benefit to choosing one practice over another. Expecting this as part the provision of health care has got to stop.

Since I opted out of the ridiculousness of the current malignant insurance system in August this year, it has been truly liberating to be more worried about doing research on the causes of polycythemia, than on correctly coding the visit to get any hope of payment from the insurance companies.

By the way, in my last meeting as member of the board for our local IPA (I resigned that day--I thought it was too weird for me to be on a board that negotiated insurance contracts when I do not do insurance contracts any more), we learned that some of the smaller insurers in our community have been sending checks to several different practices that are bouncing. If that does not show extreme arrogance, callousness, and downright fraud, I do not know what does. (Query--do you send the insurance company to collections?)

If bad checks from insurance companies becomes more wide spread, practices are going to go under very, very quickly. I hope this does not start happening in other communities.

Durango, CO

Happy-insurance-free-IMP since August, 2008

IMP since June 2005.

I believe a big reason politicians and our patients don't " get it " is that we, as a profession, have not done a good job of leading on these issues. Our patients are, as rightly points out, " passive " allies in all of this. They're allies because supporting a viable primary

care system makes intuitive sense to them; they're passive because they expect much more from their doctors than reports of misery. We (just to be clear - I mean primary care doctors as group - this is decidedly not an editorial about IMPers) complain that they don't

understand our plight. I believe they look at us and shake their heads, wondering when we'll start complaining less and leading more. They don't want to hear that " 50% of us would like to quit " - they want to hear that " 50% of primary care doctors are prepared to

act boldly " to build a new healthcare system to replace one that is broken beyond the reach of " healtchare reform " efforts. I believe that participating with insurance plans while hating the way they treat us and our

patients isn't a solution. I believe direct care, cash-only models are the only viable, long-term answer at this time to the insurance cartel's (a description I believe - and one that I really like) systematic attack on primary care. However, I applaud those

who disagree with me on this and are willing to go head to head with insurance company nonsense rather than refusing to fight with them directly - which in effect is what I am doing. One final point - I would disagree with those who say that businesses are against us on

these issues. Sure, insurance companies, big Pharma, medical device companies and others benefit greatly from the money wasted in this chaos. However, most businesses are struggling mightily with the inefficiencies inherent in a healthcare system not rooted

in great primary care infrastructure. They, like our patients, are looking for us to lead in creating a higher quality, lower cost, more ethical healtchare care system. Will we lead?CC >> i'm glad gordon has come to the conclusion that health insurance, in

> it's current form, with all kinds of policies and procedures to be> followed, failure of which results in financial flogging of doctors,> and of patients by their doctor as the instrument of the insurance

> companies, is in fact the enemy; any administrative burden which> prevents patients from receiving care is a barrier we must fight to> bring down. > megan lewis in colorado, and other similar models is the way to go for

> any small practice currently. it alleviates the administrative burden> from the doctor and allows the chance for practice financial> viability. nonetheless it is only a bridging formula, because the

> administrative burden continues to weigh on the patient, and only to> be given up at some financial cost to them. in addition, it does not> address the inherent conflict between prevention and cost savings, if

> the cost for that prevention comes directly out of the patient's> pocket. there are too many other competing interests for that money,> especially in today's economy.> we can't forget that patients are our natural allies, and that any

> formula for effective care must rely on family and other primary care> doctors, prevention, patient education and empowerment.> do we get it? do obama and daschle understand this? does anybody? > LL

>