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| The Medical Provider System - Everyone at Their Worst |
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By Sara Vannucci, Attorney
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As I turned on my computer to write, I heard Tom Brokaw in the background
lamenting the great shortage of nurses in American hospitals today. A
crisis, he called it. I seem to remember this same complaint about nursing
shortages more than twenty years ago. How is it that we have not addressed
this problem? How is it that we are not all dead by now if it is this bad?
Is the condition of the American nurse truly that bad? I use "American"
nurse generically, as, during my last hospital stay, I was generally the
only one in the room who spoke English. What have we come to that we cannot
communicate with a hospital worker who is inanely oblivious to your
Intravenous tube being in the wrong place, because your arm is as big as a
balloon.
Here's some hard facts
Let's understand how medical professionals are paid.
It's not that long ago, when I worked on my first self funded plan, that I
heard the Representative from the PPO brag that they had the deepest
discounts from their networks in the industry. Being a baby, I didn't
realize this meant that, somehow this organization had beaten down the
doctors that served the PPO's patients into accepting less than a dollar for
a dollar's work. A lot less. A really lot less, as I learned. The entire
managed care industry is balanced precariously on the backs of medical
providers who have to negotiate for how much will be carved out of their
fee, so that they may have the privilege of working in the network that now
insures their patient.
Trouble is, because their employer is so embattled on premiums, the
patient-employee is moved from carrier to carrier almost on an annual basis.
If they want to stay with their original doctors, the doctor has to move to
the new network to accommodate that. The doctor comes to them from a
position of weakness, and accepts their sixty two cents on the dollar or
whatever is paid, because... Doctors are forbidden by law to unionize or
organize in any meaningful way for the purpose of negotiating their wages
with the carriers. They are the only industry so regulated. We see an
erosion of that now, as doctors join Physician Employee organizations
(PEO's) as employees, and, abbacadabra, they can have union rights because
they're employees.
Each year is a fresh battle for the doctor, as he moves from network to
network with little bargaining leverage, and, with apologies, zero
negotiating skills and often very little business sense. I don't choose my
gall bladder surgeon for his ability to balance his checkbook.
But maybe I should. Because his limited abilities in negotiating his own
fate greatly impacts us. Here's the other twist. Many networks pay their
doctors by capitation (per head). That means he needs a lot of us to break
even. A few more to make a profit. The more he has, the more profit ...get the
drift? Capitation forces him to accumulate bunches of us. And each of us
each year gets a smaller and smaller piece of our doctor. Add to that, some
plans provide bonuses for "good case management", meaning fewer tests for
us, fewer alternative treatments, fewer surgeries.
Add to that the World Trade Center disaster...Now, as agents I'm sure this
will not come as a surprise to you, but the folks who insured the WTC also
insured lots of other things. Like doctors, maybe you and me on E&O, and
many others like officers and directors, on some type of Errors and
Omissions coverage. Needless to say, these carriers ran out of money thanks
to the WTC, and now all of the rest of us need to refill their coffers.
Malpractice insurance has doubled or tripled, at least, for doctors, and in
many places, like here in Scottsdale for most general surgeons, is
unavailable at any price.
Now, the coups de grace... this year Medicare, who pays doctors for treating
Medicare patients, reduced what they would pay by 5.4 %. They reduced the
payments to nursing homes by 13%. And, varying state by state,
budget-crunched reductions in Medicaid patient care, has produced equivalent
reductions in payments to doctors, hospitals, and nursing facilities who
care for the poor, the uninsured, and the disabled. We address these issues
in the next article. But can you find a better argument for long term care
policies that will guarantee care in a facility that is motivated to care
for you?
Doctors are closing their doors in very significant numbers. Okay, all
together now..."Who's going to take care of us?
Doctors don't want to work that way. Nurses don't want to work that way. But
that's the system, and while we're asking "who's going to take care of us,
let's also ask "Well, who's taking care of them?" Meaning our seniors. I
fear that the answer in many cases is: no-one. Again, we deal with that in
the next article. But, if you've been in a hospital, even as an outpatient,
lately, you had to have noticed that it could be a long wait until a nurse
responded. Time that should be spent with us is, instead, given to
paperwork, and I have been in hospitals with one nurse for an entire ward.
Okay, doctors are overworked, stressed, many quitting or retiring early. The
ones that stay take more and more patients. This is a major part of what's
wrong with Healthcare. But what does it have to do with the pharmaceutical
drug situation? Have you been to a doctor lately? Odds are, he magically
always has a free sample of medication for you.... no matter what's wrong with
you. Doesn't that seem a little odd to you? He appears to be better equipped
than most pharmacies.
What's going on is not a good thing. He may be dispensing samples because he
knows the patient is struggling and can't afford to buy a full dose...might
not fill the prescription. Or, he may be trying to work this into his
practice as a "value added" benefit that will keep a patient coming back.
Or, as has been documented too frequently, he may be getting little perks
for pushing preferred products to patients. Recent regulations prohibit
doctors from free vacations and other stuff now. It was not an uncommon
practice earlier, is not unheard of still. Either way, the Pharmaceutical
Industry has lured many a physician into their camp...often from the purest
intentions. Regardless, this cannot be a good thing for us, the Consumer.
Now, I'm as tired as you of hearing how Americans are all whiny babies about
wanting top healthcare, when we're not really entitled to it. But, it does
raise the ugly specter of unreasonable expectations, and the genuine
American talent for ignoring the obvious when it is inconvenient. If we are
missing nurses, and if we are missing custodial assistants, and now we have
doctors going AWOL, what's wrong with this picture? Who's going to take care
of US?
For a quick good example of what a doctor's life is today, cut and paste
this web address for a short article on why doctors are abandoning the HMO
practices for "concierge" practices, where the consumer pays $4000 to
$10,000 per year to belong to a practice, ON TOP of paying for their medical
services.
Link - Dr.
Levine's Dilemma, New York Times, May 5, 2002
Questions? Call or email Sara Vannucci, SaraVannucci@att.net or (480) 595-7462
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