A thoughtful response to my piece on good business vs good medicine. The commenter argues that the fundamental problem is our dependence on the insurance system. Consequently, our health-care system is slanted against good medicine. It is the insurance companies that forces good business on our medical practice, and the physicians are unwitting pawns. Take a read:
The assumption is that somehow good business and good medicine are at odds. I don’t think this is true. What is true is that practice under terms constrained by and defined by insurance companies is not in the interests of doctors, viability of medical practices, or good patient care. We need to see, and we need to make our patients see, that these are two separate entities. Part of the problem with American medical practice is that we have become bedfellows of insurers, making more and more accommodations to the insurers, while being persuaded, by our patients and their insurers, that these accommodations are necessary to good practice and good care. So we have allowed our practice overhead to become blown up by staffing and claims processing costs that were never part of a practice’s operations in the past. Insurers have passed many of their own point of service administrative costs to the doctors while cutting reimbursement or practicing other payment denial techniques that have further added to their bottom line. And we have been bullied into believing that we must protect our patients from the harshness of medical expenditure by accepting payment from insurers rather than demanding the payment from the user of the services, the patient.It has been a perfect strategy for the insurers and for Medicare and Medicaid. They are buffered from the patients when they fail to honor their coverage terms and the patients don’t feel as accountable for costs when they leave the doctor to file claims and wait for payment. And the administrative burden on the practice, coding, filing and other paperwork, gives the perfect opportunity for insurers to use clerical discrepancy as a reason to delay payment. (Clean-claims payment laws have not worked as advertised–there are loopholes despite this legislation).
If internal medicine has become unmanageable, doctors have been unwitting participants in making it so.
If we are to participate with insurers, there are ways to even the playing field. One is to demand immediate payment for services, if not from the patient, then from the insurer: electronic funds transfer from the insurer to the doctor at the time of service, not ten, or thirty or sixty days later, and no pay means no play.
Let the insurance companies find some other source of income besides short-term lending at the expense of the doctors.
