FOR DOCTORS AND PATIENTS
You'll find here the latest insurance changes and further fee
reductions for Primary Care; so please check in often. Remember
to check out each insurance company's "Report Card" for more detailed information and comments. If you have new
information about the insurance plans already listed on this site
or if you have reimbursement schedules for companies we haven't
listed yet, please e-mail the information to austintxmd@earthlink.net; and we'll post it here for everyone to see.
American Medical Association calls us a
"One-MD Crusade"
TEXAS MEDICINE, a publication of the
Texas Medical Association calls us
"The site everyone's talking about"
People have
visited this site
We get LOTS AND LOTS of letters. CLICK to see a few.
PLEASE WAIT
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IT'S SUMMER Any time I go for even a few days without posting some sort of
new "Bad News," I begin to get worried emails from readers, wondering
if something has happened to me. I want to forewarn everyone that I'm going to reduce the time I spend on web publishing this summer in order to spend more time with my family as well
as on other personal pursuits. After all, I'm one of those "rich
doctors" (that the insurance companies are always talking about)
who can afford to take time off. Actually, no one past age 40 can afford NOT to take time to live life to
the max as it flows inexorably past us. Almost everything anyone would ever want to know about the managed
care crisis is probably already addressed somewhere in this web
site; so I encourage my friends to spend time reading back over
the past "Bad News" pages for a while (like watching summer reruns
on TV). I'll try to put up something new from time to time (especially
any fee reductions we detect), but don't anyone worry if I'm gone
for a while. As always, please feel free to send along any newsworthy items
- I'll still be checking my email and will continue to post things
I consider urgent or timely. As Arnold said, "Ah'll be back!"
5/23/98
My Kids Are Out of School
... and Ben Dover is going to take some well-deserved vacation
time
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ABOUT DISABILITY INSURANCE Ben Dover has lamented before about how many doctors are choosing
to escape their faltering medical careers by claiming that they
were disabled and collecting on their disability insurance (See
Increasing * 12/8/97 * 2/11/98 * 2/16/98 * 2/17/98 * 2/22/98 ). What I've termed "Mock Disability" has been sucking so much
money out of the Texas Medical Association Insurance program that
they had to raise the premium rates by 130% from 1997 to 1998 just to keep the program solvent! My annual
premium jumped to $14,812(!) - mainly to support the comfortable "disability" retirement of
doctors who chose to bail out rather than keep struggling. Obviously
no Primary Care doctor makes nearly enough money to be able to
afford that kind of premium. Although I've had all my professional insurance with the TMA since
I started my practice more than 20 years ago, I was finally forced
to reduce my level of coverage and also do some comparison shopping
with other insurance programs. By reducing the amount of my disability coverage and accepting
a longer waiting period, I was able to reduce my TMA annual premium
to $8,088; but that was still much too costly. The problem is that by insuring
ourselves through the TMA, we Primary Care doctors are forced
to be in the same risk pool as the high-priced surgeons and other
sub-specialists who have historically been much more likely to
decide they are "disabled" then the going got a little rough. Fortunately, I've found a number of MUCH more affordable disability
insurance options. For example, the American Academy of Family Physicians (1-800-274-2237) offers exactly the same coverage I was getting
though the TMA (for $8,088) for only $2,306 annually. Obviously Family Practitioners are much better disability insurance
risks than surgeons; so it seems to me that FP's would be foolish to buy their disability insurance through
the TMA and thus end up subsidizing the surgeons' risk pool. Am I missing something here? I'm open to corrections if I'm wrong.
5/23/98
FAMILY PRACTITIONERS TAKE NOTE!
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It used to be that when a new patient called Ben Dover's office,
the receptionist did the only screening we needed. If she thought
they sounded nice on the phone, she'd schedule them an appointment.
It was so simple and fair and fun back then. We knew we were going
to give each patient top quality health care, and we knew they
were going to write us a check for the full amount of that day's
charges every time they were in the office. If they thought my
charges were too high, they didn't have to come back. Almost everyone
did keep coming back again and again... like for the next 20 years. Unfortunately, "managed care" has changed all that... Nowadays there's no way we'll accept a new patient without thoroughly
pre-screening them: I hate having to do this; but we're talking my survival here,
folks.
SAD BUT TRUE
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Dear Ben, I saw a link to your site in my doctor's office. I have a small company, and we are switching medical plans. I
used your list as a starting point. We then called a number of
doctor's offices, and spoke with both the doctors and their office
staff. I started with the "A" rankings, and was quite surprised
to find both doctors and their office staffs faulting these companies
for poor service, and not recommending them. We are looking at
the B and C ranked companies now. I think that a ranking of insurance companies has value. And I would prefer that my doctor get most of my insurance
money. But I also think that your insurance company rankings should
include a competency factor. Regards Lynn ____ p.s. It took a while, but I finally figured out the meaning of
your name. Cute. . Thanks very much for your input. Obviously there are endless variables one might consider when trying to rank managed care plans. However, in
order to make any sort of sense out of all the confusion, I decided
to keep it simple by designing the straightforward model we describe
in our "Assumptions" page, then applying that model as a standard to all companies.
Trying to quantify something as ephemeral as "competence" (or
"quality") of an insurance plan would render any financial analysis totally meaningless - which is exactly what the insurance companies want! They want everyone, doctors and patients and employers alike,
to remain confused as they continue fleecing us. CRITICAL POINT: Despite all that "warm, fuzzy" advertising by the insurance plans intended to make you feel that they "care
about you," all they are really interested in is MORE PROFIT (See "Business is Business"). "Quality" of health care is totally irrelevant to an insurance
corporation unless it translates into more profits. CRITICAL POINT: The fact is that no insurance company has anything whatsoever
to do with determining the "quality" of health care patients receive.
Only we DOCTORS govern the actual quality of care any particular
patient receives; and that quality depends on each individual
doctor's dedication, intelligence, competence, experience, and
integrity. It is the height of arrogance for a bunch of insurance industry
MBA's to presume that they have anything whatsoever to teach doctors
about high quality patient care when each doctor has spend at
least eight years after college learning to do just that (while
most of those insurance MBA's are actually failed pre-meds who
weren't smart enough to make the cut for medical school). It is only common sense to conclude that in the long run, those
companies that pay doctors better are the ones who will attract
(and retain) the higher quality doctors, the most highly respected doctors
who are so successful that they can pick and choose which new
patients they wish to accept into their practices. Conversely, as the better (most popular, most respected, most
booked) doctors wise up and drop off the poorest-paying plans,
those plans will be left with only the "dregs," those doctors
who are simply unable to attract significant numbers of patients from the better-paying
plans. These doctors, in order to remain halfway solvent with
their abysmally low reimbursements, have no alternative but to
churn through a staggering number of patients every day just to
keep their heads above water; and quality (i.e., attention to details, patient education,
caring, nurturing, and just plain ol' TLC) get tossed right out
the window. No matter what you were told in your phone survey, the experience
in my office has been that the companies that score better in our financial rankings are generally also those companies with whom my staff finds it
easiest to deal. Conversely, the "support" employees of the lowest-paying
companies are constantly being harassed by an unending stream
of infuriated patients and doctors' staffs; and their torment
ends up being reflected back at all of us when we are forced to
deal with them. In my office, when a new patient with one of the better-paying
plans calls us, we always find a way to get them in that same day. That's how Ben Dover skims off the cream from the available
new patient population. If a new patient from one of the lower-ranked plans calls us,
there's simply no way in the world that he'll ever get an appointment
in this office. Please consider these things when deciding on an insurance plan
for your employees. Sincerely yours, Ben Dover, MD
5/23/98
TRYING TO DECIDE ON A HEALTH INSURANCE COMPANY:
BEN DOVER SEZ:
Dear Lynn,
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ANTHEM just reduced its payment for a Tetanus/Diphtheria Booster from $13.80 to $12.42, a drop of 10%. They thought no one would notice, but Ben Dover notices everything. If we assume that you're a good doctor and are thus giving perhaps
three of these important immunizations each week, then Anthem
has just stolen another $185 from you this year and added it to their profits... and they
did it so stealthily that you'd never have realized it without
this web site. Med-Corp just reduced their payment from a 10-minute Office Visit (99212) from $42.40 to $42.00, a drop of 1%. This little cut seems insignificant compared to the way the
other companies have been raping us, but it adds up to a loss
of another $1,739 in our standard practice model. Med-Corp is still by far the best managed care plan for doctors; but Ben Dover is committed to reporting any and
all fee decreases, no matter how small they seem.
5/23/98
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5/18/98
NYLCare says in a letter that they're going to pay for six Viagra pills a month (click) that's $60x12=$720/year; so I guess they've determined that having sex less than six
times a month is health-threatening; but getting laid more often
than that is unnecessary. They're paying for Viagra for the sake
of marketing, to keep patients happy, while at the same time paying doctors peanuts!
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Sniffling, sneezing, stuffiness and outright discomfort have regularly
tormented Fort Worth retail consultant Alan Bush since last fall. Mr. Bush, who suffers from allergies, says he can't get any relief.
When he tried to refill a prescription for the popular antihistamine
Claritin in October, his doctor told him that the drug was too expensive and recommended
over-the-counter remedies. Although Mr. Bush had previous success with Claritin and was willing to pay for it, he suspects his doctor was afraid of being fined by Harris Methodist Health
Plan for exceeding a pharmacy budget set in the physician's contract
with the plan. BED DOVER SEZ: Mr. Bush, former president of Computer City, says he and other
Harris patients are caught between doctors and an insurer who are both
watching their pocketbooks. Mr. Bush says he was dropped by his doctor when he raised the cost issue. The doctor declined to comment Friday through an aide. Harris, the area's largest health maintenance organization, is
the only one to penalize doctors for writing more prescriptions than their contracts
allow. Both state insurance regulators and a Fort Worth district judge
have said Harris' policy is probably illegal. And last week, patients filed suit against the insurer over
the controversial policy. I'd say Mr. Bush's chances of finding a new doctor willing to take him on under the circumstances are slim to none because his case is going to mean negative cash flow to any doctor on the Harris Medical Plan. His best bet is to change to a better insurance plan. What doctor with a lick of sense would voluntarily accept a new
patient on whom he knew he was going to lose money from the git-go because of
lousy reimbursements. That's why Medicare patients have trouble finding a (good) Primary Care doctor willing
to take them on as a new patient.
5/18/98
HMO drug policy gets complaints
Harris says plan hasn't caused patients harm
http://www.dallasnews.com/business-nf/biz16.htm
(excerpts)
By Charles Ornstein
5/18/98
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"The realities of an HMO and a pharmacy budget clearly require
doctors to keep one eye on the patient and one eye on the economic
result of their treatment," says Mr. Bush, 44, who is still looking
for a new doctor.
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Many Harris physicians say they haven't changed their prescription
decisions as a result of the financial pressure. But some say
they know of cases such as Mr. Bush's, in which patients have
either been refused prescriptions or dropped by their doctors
because of their costly needs.
.There are probably many, many more of these cases than anyone wants to admit; but usually the doctor is clever enough and subtle enough to
find some sort of plausible excuse for easing a money-losing patient
out of his or her practice.
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"If any physician out there has information of patient dumping
or withholding of care, they are equally to blame if they don't
turn that information over to us with the circumstances and let
us investigate them," Dr. Cluck (Harris' medical director) says.
.The insurance companies want to tear down doctors' integrity yet farther (click) by encouraging them to betray one another; so that eventually
no one trusts anyone any more. See Business is Business. Also see Divide and Conquer.
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Under Harris' contracts, the company pays physicians a set monthly
fee to provide care to each HMO member. Doctors are also entitled
to spend an additional amount on prescriptions. If doctors exceed
their prescription budget, the contract requires them to pay Harris
35 percent of the additional cost. If they spend less than the budget allows, the insurer gives them
a bonus.
.Doctors in this Harris plan are given powerful incentives to restrict patient care, and many end up taking the bait... and forfeiting their integrity.
Last week, a state district judge in Fort Worth ordered Harris
to immediately stop enforcing its pharmacy policies on physicians.
The temporary injunction came as part of a class-action lawsuit
against Harris by several North Texas physicians. Last week, a
state district judge in Fort Worth ordered Harris to immediately
stop enforcing its pharmacy policies on physicians. The temporary
injunction came as part of a class-action lawsuit against Harris
by several North Texas physicians.
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Dr. J. Mike White, one of the lead plaintiffs in the suit, says
he refused to adhere to Harris' financial constraints and continues
to prescribe medications that he believes are necessary for patients.
That decision has cost him $50,000 since last May, he says.
.CRITICAL POINT: Most doctors love taking care of complicated cases - the tough cases are the real
fun and the real challenge of medicine for us. That's what we've spend a lifetime
training to do. However, these days the managed care companies have backed us into a corner from which we're scratching for financial survival; and many solo Primary Care doctors simply cannot afford to "waste"
precious time and limited resources on "high-maintenance" patients
when doing so means they won't be able to afford to pay their
kid's college tuition.
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BEN DOVER SEZ: Patients and employers are being required to pay in larger and
larger premiums while the managed care companies pay out less
and less to the actual providers of care. Anything they don't pay out they immediately convert to corporate profits, obscenely large executive bonuses, and shareholder
dividends; so that money is gone, GONE, GONE! So far, the system has continued to work because we doctors continue giving superb care to our patients as if nothing had happened. So far, the managed care companies have been able to grow like
a Ponzi Scheme by signing up only young, employed, healthy workers. However, they have already suckered
most of these high-premium-paying, low-health-care-cost patients
into their web (i.e., they've picked all the "low-hanging fruit").
The days of huge, easy profits are past; and the managed care
companies are now faced with an aging patient population to whom
they've promised everything modern medicine has to offer - a level
of care they simply cannot deliver because there'll never be enough
money for that. And what's become of all the "surplus" money we patients have
already paid in to the insurance companies through our sky-high
premiums? GONE... paid out as "profits" (click) at the same time the system is going broke. For the past several years the managed care companies have been
able to bolster their profits by repeatedly slashing physician
fees, but most doctors are now (or soon will be) on the ropes
financially. Many are likely leave medicine entirely rather than
shoulder all this responsibility while being paid chicken feed. When the mega-corporations are no longer able to make huge profits
on health care, they will move on to other, more profitable endeavors,
abandoning the American people to a health care system which they
have financially disemboweled. That's when the government will be "forced" to step in to "save
the system." It'll be the Savings and Loan Debacle of the 80's
all over again in another form - with the corporations once again
the richer while taxpayers get left holding the bill.
5/16/98
PONZI SCHEME
Currently the managed health care companies are still able to suck
enormous profits out of the health care system, but those days
are about over.
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