Why one doctor throws away insurer mailings

Why one doctor throws away insurer mailings

There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against.

I received the following mailing:

We want you to screen our members for cancer.  Please do these things:

  • Call the member to discuss colorectal, skin, and prostate cancer screening.
  • Refer the member for colonoscopy, or schedule an appointment for skin and prostate cancer screening.
  • Flag each member’s chart to remind you to discuss cancer screening at his or her next office visit.
  • Enclosed please find several hundred dollars extra in payment for your time.

Obviously I made up that last point.

Following this was a two-page, single-spaced list of patients, some of whom have never been to see me, yet are considered “members” because they were randomly assigned to my office when their employer randomly assigned them to the new plan because they could never be bothered to plow through all that messy paperwork.

Know what I did with that mailing? I pitched it.

FIrst of all, I always discuss appropriate cancer screening with all patients at every visit. Blood pressure check on new med? Sure. When was your last mammogram? Summer cold? Fluids, rest, and analgesics, and you don’t need a colonoscopy because you’re 45 and your family history of colorectal cancer was a grandfather diagnosed in his 70s (doesn’t change the default recommendation to start screening at age 50.) Yes, that rash looks like Lyme disease, and while you’re here, we really should schedule you to come back for a pap since it’s been six years since the last one.

Next, what does “flag the chart” mean in the age of electrons? And why do I need a special note telling me to do something I always do every time anyway? Talk about alarm fatigue.

My job is to take care of patients. (Not populations, but that’s a different post.) One at a time, as they come into my office. No, the office visit isn’t the only way I provide care anymore, but establishing a doctor-patient relationship still requires a face-to-face encounter. After that, it’s damn the appointments, full electrons ahead (phone, text, email, Facebook message, etc.).

Outside of that, if they want me to provide professional services (like calling patients, discussing screening tests, making referrals) they need to pay me. Can’t be bothered? Then I’ll pitch their mailing. Every time.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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  • civisisus

    Lucy’s a special doctor who always does the right thing, every time. Lucy is above any form of performance protocols. Lucy imagines that just about everything about medicine in the US would be better if doctors were only left alone to do as they pleased.

    We can’t wait for Lucy to inform us why SHE is about “patients, not populations”: not people, of course, because with patients she’s in command, but people she’d need to collaborate with, roughly on the same plane of existence.

    Please spare us, Lucy.

    • guest

      The objection being registered above is not to performance protocols. Doctors want to do the best they can for their patients and performance protocols can be an important part of helping maintain good care.

      The above described letter,however, does not outline a performance protocol. It is an attempt by a third party payer to minimize its medical loss ratio (the amount of our premium dollar that actually gets spent on medical care for us) by bullying the doctor into providing free screening services over the telephone.

      It would be just as easy for that insurer to send a letter to its patient members informing them that it was time for their annual physical and that they should discuss cancer screening with their doctor when they go in, and a similar letter alerting the doctor that the patient was coming in to discuss cancer screening. That approach would actually be the collaborative way to engage the patient as an equal partner in his or her care.

      However, that approach, although more respectful of the patient and generally more likely to result in the patient getting good care, costs money. The bottom line is that our insurance companies don’t want to pay our doctors to take the time to provide good care. And the results are speaking for themselves.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Guess what patients do with those letters from their insurer/employer benefactors? Pitch them….
        Making the doctor pay for someone to make actual phone calls is pretty clever.

    • PoliticallyIncorrectMD

      Why so much anger? Did your doctor refused to prescribe an antibiotic for your viral cold? If you want to be “in command” perhaps you should go to school like Lucy did. Or better yet, Google you symptoms and treat it with some voodoo medicine you by online. Let the natural selection work.

    • Sandra K.

      Lucy is the kind of doctor I wish I had. I don’t know why you’re so snarky.

  • Tiredoc

    If you as a physician accept capitated payments, then you are responsible for their care irregardless of whether or not they come to see you. As a physician it is relatively inexpensive to set up phone blasts from Televox, etc

    • Guest

      Next time just say “give in”. It’s less wordy.

      If you want to stay in the boat and go over the falls, go right ahead. I’m swimming for the shore. We both may die but if I do, at least I died trying.

      • Tiredoc

        I’m not saying “give in,” I’m saying live up to the terms of the contract. I don’t accept capitation for this reason. To mix your metaphor, I wouldn’t get in that water to begin with.

        • southerndoc1

          Fee for service insurers send out this crap also: it’s not limited to capitated plans.
          I don’t think dermatologists, radiologists, or anesthesiologists get this kind of junk: it’s only the primary care docs who are expected to do this work for free.

    • kjindal

      I echo southerndoc – I get alerts like this from FFS insurers too; I even get alerts like “consider starting an ACE inhibitor in mr.X, who has filled a prescription for diabetes medication”- only problem is, mr.X died 3 years ago!!! What a complete waste of my time and taxpayer money (for the medicare HMOs).
      And do you mean “irregardless” or “regardless”?

    • Tiredoc

      Someone who is a medical lawyer should chime in on this one. As far as I know, if it isn’t something that we sign and isn’t generated by a provider of some face-to-face service, then we can round-file it. However, if it’s a national protocol for preventive health, mammogram, pap, etc. it’s probably a good idea for general legal protection to go ahead and set up a system to track and make sure our patients do it.

      As for the patients that haven’t shown up in years and have stuff due, it’s probably a good idea to go ahead and send letters to have them come in or officially sign them off as patients.

      At some point, we are going to have to be like my auto dealer who calls to set up oil changes. Getting paid for humans as much as the auto dealer does for cars is an entirely different subject.

    • Ryan

      Irregardless, huh?

  • Scott Stallings

    I also don’t get paid for anything but face-to-face encounters, so I hand that all too familiar stack of paper to my front desk staff and tell them to book every one of them a preventive care appt. If they don’t regularly come in then they need to be seen. It can help grow your practice.

    • Sara Stein MD

      Same with forms that need to be filled out. Face to face.

  • SBornfeld

    Dr. H:
    Isn’t it easy enough to distinguish what is boilerplate recommendations the insurance company puts in all their literature to convince groups and patients that they care, they reeely care, as opposed to really requiring specific tests and/or procedures?
    I’m assuming you do normal standard-of-care stuff.
    I’m a dentist–I’ve been on participating “provider” panels for 35 years (and gradually have pulled out of the worst); they always have provisions like “you are not to disadvantage our members in obtaining appointments no matter how shitty our reimbursement rates are”. Yeah, they’re really going to know.
    If you can’t live with the real plan provisions (and there have been many that I cannot) then you don’t deal with them. But this example you give seems like you’re working yourself up for nothing.
    (Of course, I’m sure there are plenty of real reasons to ditch the insurance companies).

  • Ray Foster

    The insuror telling you what to do and how to do it is practicing medicine without a license. I pitch every one of those types of correspondence as well, with one difference– I will not waste my time reading the entire thing.

  • Tiredoc

    For those scolds out there commenting on irrregardless, speak the phrase “care regardless” and then “care irregardless.” It is a non-standard but acceptable synonym for regardless and useful in particular in spoken English with after words that end in the “r” sound. Y’all can akse us Southerners any question you want about proper English.

    • Jonathan

      “Irregardless” is not an acceptable word at all. It is improper English. People who use it look silly.

      • Tamara

        I am a Southerner, born and bred, and I have no time for people trying to sound smarter than they are by using words that aren’t even words. “Regardless” is a perfectly nice word — no need to add an extra syllable to it to try to sound fancy.

  • Tiredoc

    Fine. “Care irrespective” then.

    When your correction adds to the readability or clarifies the intent of my post, I appreciate the input. When you ignore the content of my post and fail to comment on the thread itself, you are engaging in linguistic ad hominem.

    To quote Tamara, “I have no time for people trying to sound smarter than they are by using words that aren’t even words.” That’s a rather explicit mea culpa for ignoring the message in favor of discrediting the messenger.

    There’s a committee in my specialty that comes up with the “proper” terms for medical conditions all of the time. They switched the universally understood “Quadriplegic” to “Tetraplegic” because they didn’t like mixing Latin and Greek root words.

    I suspect that there’s a similar committee out there for both Jonathan and Tamara to provide their input to like minded colleagues. For the record, there is no correlation whatsoever between spelling ability, handwriting ability, correct grammar and intelligence.

    If I may presume to speak for my fellow grammatical quadriplegics in the no doubt tiny audience following this thread, I will state my point with no extra syllables.

    Bite me.

  • Shirie Leng, MD

    Lucy makes a good point. I, an MD, almost never go to my PMD. Is she getting penalized because of my “poor compliance” with screening tests I know I don’t need and won’t get? My pediatrician gives me lab slips to check my kids lead levels and hemoglobin. If I don’t get the tests done does she pay the price? Should the doctor pay for the patient’s unwillingness to “cooperate?” Are doctors paying for patient’s rights to refuse? Just asking.

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