When I go out to eat, and it is obvious who is the host, the host, in subtle but noticable ways gets closer attention. They can’t help it, it is human nature. If 60% of a docs practice is from insurer X who can put him off the panel or in a lower tier and basically roll op his practice, and if that insurer wants him to do things a certain way because it save him money, unless he is what those of us in utilization management refer to as a “problem doctor” (meaning stubbornly resistant to our efforts to get him to practice out way), then he will comply and push his patients to comply–whether he rationalizes his compromise or openely resents it.

Doctors are human beings. You want him to work for you, pay him.

When I go out to dinner and if my spouse or friend pays for the meal, it doesn’t matter. I am being served. I AM the customer.

Physicans forget it’s who you are serving. Not who is paying the bill. And they get mad at who is paying the bill and they get mad when the bill isn’t paid.

I have never seen a place of business get mad when they are being paid money for a service. As long as the check is good and credit card is good.

The other big word is “service”. Yes the money follows the patient. The money follows me if I go out to eat or to Home Depot.

Yes, you should make it clear. He who pays the piper will always call the tune. If the check comes from the insurer, that is who you work for. If it comes from the patient, then and only then is the patient the actual customer. I have practice private pay only, HMO, served as an HMO administrator, and as a utilization manager for a government payor. It is clear in watching how the behavior of docs and other providers shift with payment, and even in honesty, my own, that the care follows the payment.

Only in private pay is the doctor-patient relationship uncompromised.

Pretending that it is not in any other system, is indeed, a “game”.

I am a medical professional working in a New Orleans Medical Home pilot and Post Katrina it has been a viable model and they physicians are beginning to recognize it.

As for your “risk” to your viability as a practitioner, the patient is the paying customer, or I should say their insurance pays you. No patients, no practice.

As far as the insurers, I am a well employed professional. If it wasn’t for the big bad insurers, I would be going to a doctor or hospital because even with my salary, I CAN’T AFFORD TO PAY THE BILLS! Phyisicans want the insurers money. They sure don’t want to see the indigent.

You want to play, you have to play the game!