This is an opinion piece I wrote to the Fort Myers News-Press concerning an article they recently wrote titled, “Patients hit with add-on charges,” by Frank Gluck, The News-Press, Jan. 23.
“Drs. Douglas Henricks and Rob Simmons are my practicing partners. Frank Gluck’s article suggested their recent patient contract offers were violating health insurance companies’ contractual “rules.” I wish to clarify to the public that our group does not have contracts with private health insurance companies, and thus their rules do not apply. The contracts recently offered to patients by my partners are voluntary and not new to the local market. Such payment offers are widely used in Naples and have been for several years. Many patients have been asking for such concierge service and thus there is consumer market pressure to offer this. Several years ago, we canceled private health insurance contracts because of inadequate reimbursement and ever-expanding controls/regulation being place upon our work. Presently, the system is setting physician fee schedules, not distinguishing quality and at the same time increasing the workload of patient care. Denial of physician-ordered care results in more office and physician time (through exception requests and other authorization processes) which is not covered by the current fee schedules. Cost savings to the insurance companies that result from denials have yet to materialize in the form of less expensive premiums.
In my 18 years of practice, I haven’t seen premiums go down one single time.
At the heart of the matter is that Medicare is setting the fee schedule for physician evaluation and management. Medicare does not negotiate fees with physicians; it mandates them. Medicare does not distinguish whether the care is provided by a sub specialist, board certified physician, physician assistant or a nurse practitioner – the payment is the same. There is no incentive to provide quality. These policies started in the mid-1990s and are resulting in a slow fall to the bottom for U.S. health care.
Private health insurance plans use Medicare’s fee schedule as the benchmark for their contract negotiations. They actually are paying physicians even less in Lee County. Private insurers figure that if the doctors will work for the Medicare fee schedule, they need not pay any more than Medicare does.
Physicians do not need to apologize for expecting to be reasonably compensated for their time and expertise. The system’s pay caps with ever rising demands and work lists is untenable. The latest health care law adds further regulation (longer work lists). I am concerned the system is going to fall apart.Mr. Gluck’s article does serve to highlight that things are at a tipping point. Physicians should be allowed to set their own fees but Medicare should only subsidize patients what its budget allows. Patients would only pay for services that they personally use, rather than some of the patient group paying annual lump sums to subsidize the rest (basically what current concierge contracts accomplish).
I hope this commentary serves to awaken the public to start taking charge of how their dollars are being deployed. We should be offered properly priced insurance contracts which place the patients in the driver’s seat for consumption. This means more “pay as you use services” options with a true catastrophic insurance policy as an option. This would keep unnecessary wasted resources from being used up and it would mean your insurance company would only enter the picture when you really had a significant health care cost.
We all pay for the maintenance of our cars and homes and only call on our insurance policies when there has been a wreck, flood or fire. It doesn’t need to be any different for health care services.”