Medical insurance company RANT

[sweeps]

Steve, believe me, I know how much time, money and -- quite frankly -- crap doctors have to go through to be educated, certified and insured. I'm not at all trying to tear down or belittle doctors.

But GD, health care premiums are going through the roof. I seriously cannot continue to pay these premiums if they continue on this path. Some serious changes have to be done to the health care system. And this is one place to start.

If insurance companies pay more, ultimately that means I pay more. So not only am I interested in lowering my direct health care costs, but also my indirect health care costs (i.e. what my insurance company pays on my behalf).

[Scanner]

Sweeps,

The thing is . . .I am not sure the family doctor is the natural target.

After 2 decades of trying to reform healthcare. . .2/3rds of expenditures still remain in the hospital.

Redirecting people away from DisneySteve and to a NP. . .okay, it may help a little but it's like putting a little silly putty in a dam that's ready to burst.

I think the natural choices to make are Terry Schiavo's and other end of life issues.

Some serious end of life rationing. . .hell, call me radical but I think dignified euthanasia has a place.

But Conservatives have sentimental religious values on such issues and thus, no real reform ever really happens. We just get Minute Clinics and other superficial reform.

Don't expect your premiums to go down, Sweeps. Just a few copay savings per year.

[disneysteve]

Redirecting people away from DisneySteve and to a NP. . .okay, it may help a little

And I'm not so sure it will even help. By sending patients for episodic care, rather than continuing care, you will miss things. Things like blood pressure, diabetes, high cholesterol, cancer screenings - things your family doctor does that the urgent clinic doesn't do. A good family doctor LOWERS medical costs by doing screenings and catching things early when they are minor and easily treated. When a patient comes to me for an ear infection, I review his chart. I see that his BP was up and he missed his follow-up. Or I see that he was supposed to have a repeat PSA 3 months ago and didn't show up. Or I see that the last refill on his cholesterol pill was 2 months ago. That sick visit is an opportunity for me to address other issues. Will the clinic do that? Of course not, because they won't know about those problems. The long-term result of that will be allowing more serious problems to go untreated until they cause complications, resulting in higher medical costs that might have been avoided.

[Scanner]

Steve,

Good case you make but you should know. . .medical insurance is about catastrophic coverage, not about prevention.

That being said, there is a new trend that you may support (incentivizing and disincentivizing).

There may be premium assessments to people who are obese, don't take their blood pressure meds, dont take their diabetes, and who smoke.

Big brother may be coming and you may stand to gain from incentivizing.

If I know I'll be socked an extra 100/month for not showing up for my prostate exam. . .you'll bet many people will be calling.

Big brother knows best.

[disneysteve]

medical insurance is about catastrophic coverage, not about prevention.

What annoys me, though, is that they put on a big show to make it seem like they are all about prevention. They run a huge health fair at the PA convention center every spring where they do BP and diabetes and cholesterol and osteoporosis screenings. They send patients newsletters with all kinds of health tips. They screen our charts to make sure we are doing all the preventative screenings. They track ER utilization and send patients and doctors letters encouraging regular follow-up visits to lessen things like ER visits for asthma. So it really looks like they care about prevention, because it does truly save them money over time. But when you dig deeper and see them doing things like this, discouraging patients from seeing their family doctor, you realize that they don't give a damn about prevention. All that matters is costs, and costs today, not long term costs.

[disneysteve]

That being said, there is a new trend that you may support (incentivizing and disincentivizing).

There may be premium assessments to people who are obese, don't take their blood pressure meds, dont take their diabetes, and who smoke.

Big brother may be coming and you may stand to gain from incentivizing.

That's the sad part, though. The doctor won't benefit at all. All that will do is create more work for me and make more money for the insurance company. That extra premium charge isn't going to go to me. It is going to go to the insurance company.

[Scanner]

But it would encourage more visits to you. . .more work should mean more money, unless you are capitated.

If I know I don't show up for that PSA, that I am socked an extra $50.00/month, I'll show up and pay my $10 copay and follow doctor's orders.

I am not sure what exactly you are asking for here - you were complaining that patients were being diverted from you. . .this is a way of having them refunneled back to you.

[disneysteve]

I am not sure what exactly you are asking for here - you were complaining that patients were being diverted from you. . .this is a way of having them refunneled back to you.

Encouraging patients to come in for their preventative stuff is great. I support that. But that won't solve the problem I started the thread about - also encouraging them to go elsewhere for acute care.

I just reviewed the "menu" for Minute Clinic. If I start losing a significant number of patients for allergies, bladder infections, bronchitis, ear infections, pink eye, sinus infections, strep throat, pregnancy tests, suture removal, camp physicals, ringworm, burns and athlete's foot (all things that they handle) along with routine vaccinations, an increase in preventative visits isn't going to matter because we will be out of business.

[maat55]

The one big fact not mentioned here is that these problems are largely due to the influence of lawyers. I've heard that 70% of the lawyers in the world are in the US. Our country is strangled with unecessary laws and lawsuits. Lawyers and special interest groups are leaches on society and the citizens of this country are like the frog in the boiling pot.

[disneysteve]

Talk about irony. I'm sitting in my office doing paperwork. Guess what is in my mail? A letter from the retail clinic company inviting me to apply to be a Medical Director for them. Perhaps the best way to beat them is to join them.

[sweeps]

Talk about irony. I'm sitting in my office doing paperwork. Guess what is in my mail? A letter from the retail clinic company inviting me to apply to be a Medical Director for them. Perhaps the best way to beat them is to join them.

LOL. Might be a good move!

[Scanner]

an increase in preventative visits isn't going to matter because we will be out of business.

I don't know your business so I can't comment there. I would think you may be able to concentrate your practice to who really needs more complicated medical care - hypertension, depression and diabetes probably being tops.

I am not sure the Minute Clinics would be in a position to run things like that and I am positive I wouldn't use them for that if I had one of those conditions.

So. . .wouldn't you be getting higher reimbursement based on the complexity of those cases vs. a simple burn?

Again, I don't know but I would think your expertise could be better spent as one poster noted above - you don't send in a network engineer to fix a loose wire.

It may not be the end of the world to farm these things out and concentrate on the really sick people.

Just trying to be an optomist for you. Again, I don't know your business but I do know family docs have been hurting with the ironic part being that there are shortages of them.

[disneysteve]

I would think you may be able to concentrate your practice to who really needs more complicated medical care - hypertension, depression and diabetes probably being tops.

I am not sure the Minute Clinics would be in a position to run things like that and I am positive I wouldn't use them for that if I had one of those conditions.

So. . .wouldn't you be getting higher reimbursement based on the complexity of those cases vs. a simple burn?

Yes, we get higher reimbursement for more complex cases, but routine care is still the bread and butter of a practice. I saw 33 patients today. Without actually going back and pulling all the files, I'd estimate that 75% of them were for acute care - flu, respiratory infections, stomach viruses, a couple of sports physicals, 2 cases of ringworm, a bladder infection, an ear infection... If we were to lose a lot of those patients, I don't think we could survive just on the other stuff. Also, keep in mind that caring for the chronic illnesses is also more time consuming and uses more office resources doing referrals, reviewing test results, communicating and coordinating care with specialists and such, so the higher reimbursement is offset by the additional time spent on those patients.

[jIM_Ohio]

At a "Medistop" clinic, they have published prices for conditions (Sinus infection $65.00, Ear infection $49.00).

That's not only great from their perspective but great from a consumer cash-and-go perspective if you don't have insurance.

I just don't know how much it's going to cost to visit the family doctor. It's a huge unknown. It could be $70 dollars. It could be a lot more. I went to the one next door to my practice and the next thing I knew, I was hooked up to an EKG monitor for 24 hours for a partial bundle branch block. Count in the ultrasound of my heart. . .and the ins. co. was out a few thousand for a sinus infection visit (originally).

This is the single biggest with health care, IMO.

As many of you know, my wife is pregant with twins. We used some fertility treatments to get pregant, and the bills for this treatment do not stop coming in.

In 2007 we were covered by BCBS under a PPO plan from my employer. I don't know what the deductables were, or how the full insurance thing works (who pays what to whom), but I can tell you there are inefficiencies, and those ineffiencies are lining someone's pocket book.

Example:

My insurance covered a portion of the fertility treatment. We knew that going in $7500 lifetime benefit I think. The Procedure we were looking at was 10k, and that did not include the drugs.

We went to an orientation at the doctor's office, They gave each couple a folder and "estimated" the bill for us. Which drugs would be used, how to order them, what doctor visit A would cost, then visit B, then visit C etc...

Well when the bills come, they come in one at a time, from many many different companies. Lab 1 for this, lab 2 for that, hospital 1 for this, doctor's office 2 for that.

I have NO IDEA how much the procedure cost, I have no idea what the insurance actually covered. Not a freakin clue- because the bills are still coming in (got one last week for a visit in October). It was $5 for a handling charge or lab charge or something like that.

If I go to a mechanic, they give me an estimate for parts and an estimate for labor.

If I go buy a house there is a good faith estimate for closing costs, with item numbers and summaries which I can use to compare lenders.

If I go and buy a big screen TV and have it delivered, I know how much I paid for the TV, the delivery, the warranty and the installation.

If I go to a doctor, I bet the doctor himself does not know how much the visit cost. If I ask my insurance company, they may not know either. So trying to compare cost at doctor's office A vs costs at doctor's office B is impossible.

My opinion is that health insurance is closely related to the employer you work for, and you can only change coverage once per year based on law. This makes little sense to me.

If health insurance were done similar to life insurance or car insurance, then it would be made much more efficient. HSA's work similar to car insurance, IMO.

But that still does not fix the "single point man" needed for good health care. I want one bill, and I want my doctor's office to be point man for all billing. I am willing to pay my doctor more for this, because more than likely the efficiency saves me time, and might actually lower the cost of some things.

[asmom]

I agree that it isn't fair that you are forced to charge a co-pay and the minute clinics are not.

You might not like me for saying this but it's all so ironic. For the past few years, docs have spent a lot of money and influence lobbying to protect their turf from other disciplines allegedly in the name of safety and patient care but if we are honest, it's also about money and power. Now they are being beat at their own game by the corporations.

The concerns you raise about follow-up and prevention are valid. However you are not competing against a co-pay but convenience. If you could find some way to make a visit to your office less time-consuming and less frustrating, then the Minute Clinics would not stand a chance. Physicians' offices tend to be very rigid; they open at 9:00, close for an hour at lunch(or longer) and close at 4:30. If you don't like it, go to the ER. You get there, you wait in the waiting room, you wait again in the exam room to see the doc and you wait again to check out. Going to the doctor can take a significant portion of your day which is not really acceptable to people who work. It's all the more frustrating if it's for something relatively simple like an UTI or conjuctivitis.