Tuesday, March 07, 2006

Doctor vs. patient?

…Big no-no in direct marketing: Telling the customer all the things you won’t do.

…HA took her mother to the doctor and the place was plastered with signs saying that due to cuts in reimbursement from Medicare and insurance companies, the doctor would only discuss one ailment per visit. Patients should prepare to make more appointments for each problem.

…Getting a form filled out was another visit, the signs noted.

…What if we paid a couple of copays instead? Wouldn’t that save taking off work, arranging transportation, and disrupting life over and over to get our whole selves treated?

…Shouldn’t doctors be worried about our whole selves? Or is that a quaint notion now?

…What is the point of this? Aren’t we—doctor and patient—in this insurance nonsense together? We are paying more, getting less, and now are being told we are going to be “disciplined” for something that isn’t our fault.


Bill Thomasson said...

I would strongly argue that this illustrates the benefits of capitation (i.e., HMOs). If doctors are getting paid a fixed amount for every patient on their list, they have no incentive to "unbundle" services in this way.

While they have every incentive to keep their patients healthy, rather than letting them get sick and then collecting pay for treating what has gone wrong.

Star said...

I think capitation is long gone. I don't know of any HMOs that are capitated anymore. Maybe Kaiser?Readers?

I thought this was damn tacky, myself! Gosh, let's make the patients take the hit for gaming the system!

Bill Thomasson said...

News to me. But how would we find out? Information about an HMO's arrangements with its network physicians is probably available somewhere, but I don't know where.

I'm pretty sure Kaiser physicians aren't capitated, though. We don't have Kaiser in this area, but it's always been my understanding that Kaiser physicians are employed by the plan. That means they draw a salary rather than a per-patient capitation fee.

Star said...

Yes, I think Kaiser is--or was--a closed, salaried model. I could be out of date on this. My days at Managed Care magazine are long gone. I do know--or think I know--that most docs now have a contract with the HMO, saying they will be reimbursed x amt per coded procedure. They are not paid a set amt per patient per year no matter what they did or didn't do for the person. That system, of course, did inspire the docs to keep people healthy so they don't come back asking for some expensive service. But I think the low cost of it did make people think health care was a pretty smokin' deal and it might have been abused.

Bill Thomasson said...

Interesting. And is that why we're suddenly seeing health insurance costs skyrocket? Or is that solely because people on average are getting older and developing health problems no matter how good their preventive care?

I don't know.