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FOREWORD
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For over twenty years I have loved being a doctor. I
used to drive to work every day with a joyful heart, looking forward to
seeing and helping all my patients who have also become my friends over the
years.
Nowadays I drive to work each morning
with a heavy heart and a knot in my stomach, dreading the day, filled with
resentment about what's being done to my profession by the medical insurance
industry and wondering what the next bad news will be. I always assumed I
would continue to love practicing medicine until I was too old to continue.
Now I find myself considering, more and more seriously every day, whether I
should retire and do something else with the rest of my life.
One voice inside me shouts ever more loudly, "If I'm not going to be
paid fairly, what's the point in working all the long hours and having all
this responsibility."
The other voice says softly, "But I love this work, and I love these
people!"
What should I do?
HOW BAD IS IT?
I recently calculated my projected income if I were to work a full schedule
seeing only patients from one of several managed care plans for an
entire year. The facts and figures presented on this website are rock-solid
and easily verified. They lead inescapably to conclusions that should scare
the socks off any Primary Care doctor who reads them (it sure scared the heck
out of me once I started to look seriously at the numbers!) I hope that by
presenting this information in clear, understandable form I can help the
readers (doctors and their patients alike) realize just how deadly serious
the looming crisis is becoming.
Because every insurance plan varies from
every other plan in what it pays for each different physician service, trying
to sort out which companies pay doctors better can become confusing. However,
Office Visit fees are by far the most important income source in a medical
office; so if we simply structure the comparison so that we're evaluating
potential income as if it all came only from that one source, it then
becomes very simple to rank the different insurance plans.
As a brief example, my calculations show that if I worked as hard as I could
possibly work for an entire year with every appointment full, seeing
every patient I could possibly see from one of the insurance programs below,
the maximum amount I could earn from Office Visit fees (only) would be
as shown (see Assumptions).
You may click on any company name to see how its income amount was
calculated.
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Yes,
you read correctly. Those are negative
income figures! This means
that all Office Visit payments from certain companies for an entire year
wouldn't even cover the overhead
in a typical medical office. This means that in my practice, the Office
Visits of patients on the lower-paying plans are actually being subsidized
by what I earn from the better-paying plans. Unfortunately, all the plans are
cutting their reimbursements; and there will soon be little left to subsidize
anyone.
If you find this difficult to believe, please
read on. You will find all the information necessary to support these
conclusions at this web site.
My real dilemma is the same as that of
most doctors: I'm involved with my patients; I care about them; and I've always done a darned good job of doctoring
them. Some I've treated for over 20 years; I've watched their children grow
up, get married; and I now take care of some of their children. Do I
simply "dump" these people and sever those treasured relationships
because their employer has selected bad health insurance for them? That's not
an easy decision. Until recently I never seriously considered the possibility
because "everything sort of worked out" at the end of each year;
and my income, although shrinking, was adequate. However, now that almost
every insurance plan is either slashing its payments for Office Visits or
eliminating the minor profit we used to make on lab work; it's getting harder
and harder to rationalize "wasting" valuable time on patients from
the lower-paying plans.
It's rapidly becoming a survival issue. If current trends
continue, I project that I'm going to have problems even covering my office
overhead in only another year or two (let alone taking home any personal
income) if I don't drop the lower-paying insurance plans.
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INTRODUCTION
Most people are aware that the entire health care delivery
system in the US has been changing rapidly over the past few years. We all
realize that our health insurance premiums are sky-rocketing; yet we also
keep hearing that the fees insurance companies are paying to doctors are
shrinking drastically. We doctors have been so busy trying to take good care
of our patients that we've just "gone with the flow" rather than
become involved. Now we're about to drown in that flow.
We've Had "Bad Feelings", But
We've Lacked Solid Information
The dilemma for everyone impacted
by the growing power of the managed care plans has been how to obtain
information with which to make intelligent decisions about health care before
committing to participation in one plan or another. The insurance companies
obviously have no motivation whatsoever to give doctors and the public the
real facts and figures in any usable form. They don't want doctors to share
the facts with each other, and they certainly don't want doctors to share
these facts with our patients. They don't want any of us to know what
enormous profits they're making from their inflated premiums. As long as they
can keep us confused, distracted, and off balance about their actions and
intentions, they are pretty much free to behave in any way they please.
The Information That Really Matters Can
Now Be Found On This Website
At this site we will try to
present a rational view of the crisis in medicine and support that view with
as many irrefutable facts and as many actual dollar figures as possible.
Hopefully, doctors, patients, and corporate executives weighing health
insurance options for their employees will find some of this information
useful as they make their decisions.
Doctors and Patients Are the Only Ones
Being Kept in the Dark
Some insurance plans pay doctors fair reimbursements for their services while
the payments from some other plans are absolutely
abysmal. Insurance companies
compete by making it their business to know exactly what their competitors
are doing at all times; so there can be no doubt that each company knows
precisely what every other company is paying, CPT code by code, almost as
soon as the competitor promulgates a new fee schedule. The insurance
companies already know all the facts we are sharing here; but doctors and
patients have never before had at their fingertips an easily understandable
reference comparing the insurance reimbursements from different companies. I
happen to be the most familiar with the plight of Primary Care (Internal
Medicine, Family Practice, and Pediatrics) in Austin, Texas; so all of the
initial data presented will be from that area. Depending on the response, the
scope of this web site could expand in the future.
We Must Break the Insurance Company
Stranglehold
If there's to be any hope of breaking the insurance companies' stranglehold
on American medicine, especially Primary Care, their actual physician
reimbursement histories must become freely and widely distributed. If doctors
and patients alike are able to compare what the different plans are paying
the actual providers of health care, everyone will for the first time have
the information needed to make intelligent decisions concerning future
participation in any specific insurance plan. The information provided on
this web site will equip Primary Care physicians with all the facts we need
in order to make intelligent decisions about which insurance plans to accept.
When a company lowers its reimbursements, we will try to post the new fees on this web site
as soon as we detect the change. In this way, egregiously low payments by the
poor-paying companies can be spotlighted for all to see and condemn. At the
same time, good insurance plans worthy of praise can be easily identified and
rewarded with more of our business. If doctors understand clearly which companies
are the poorest payers, it is my hope that large numbers of us will decide to
drop off the provider panels of the poorer-paying plans, thus forcing the
plans to provide better reimbursements to lure us back. No health plan can
successfully market itself to employers if all its Primary Care physicians
have quit.
No Intention to "Fix Prices"
As author of this web site I wish to state clearly that in publishing this
material, it is not my intention to advise doctors as to what fees they ought
to charge for their services. The purpose of this site is to help doctors make sense out of all the raw reimbursement
data they already have in their offices, and I have done my best to insure that every number
stated is honest and accurate. The conclusions I have drawn are my personal
opinions only, and I am open to input and correction from anyone if I have
made mistakes. Any insurance company that finds inaccuracies in the fee
schedule I'm showing for them (or in my interpretations) is invited to email
their corrections to me for immediate posting. This web site will always
endeavor to be honest and fair, even to the insurance corporations.
Doctors cannot give the appearance of uniting
to "fix prices" without running afoul of the anti-trust laws; so we cannot get together and decide what our
fees should be. However, there is certainly nothing preventing each
individual doctor from making a decision for his/her own practice concerning
the minimum fees he/she is willing to accept from an insurance plan. If it is
obvious that a plan is grossly underpaying, then many of us, acting
independently, may choose either to resign from that low-paying plan or else
refuse to accept any more new patients from that plan. If enough doctors
(acting independently) choose to resign from an insurance plan, the plan will
no longer be able to market itself effectively to corporate health insurance
decision-makers and will perhaps feel moved to propose an improved
reimbursement schedule for Primary Care physicians.
Will "Managed Care" Mean the End of
(Caring) Primary Care?
Primary Care doctors (Internal Medicine, Family Practice, Pediatrics) have
always earned substantially less than most other fields of medicine; but most
of us love what we do and are deeply involved in the lives of our long-time
patients. Unfortunately, because we've always earned less, we are being
especially hard-hit by the malignant fee cuts recently inflicted on all
doctors by the managed care insurance plans. Many of us are not going to
survive, at least not as caring, involved, attentive, responsive private
practitioners.
This is the crisis in which the majority of excellent, hard-working
Primary Care doctors now find themselves. There
is something very, very wrong
about this new system that pulls the rug right out from under all the
dedicated medical professionals who have committed their lives to caring for
others, the ones who are actually delivering the medical care and thus
allowing the entire system to function. Especially hard hit are the new,
young doctors who have just finished their training with huge student loans
to repay only to find their starting paychecks as a "real doctor"
are only slightly more than they earned as residents during all those
"poverty years" of training.
We doctors cannot turn aside this tidal wave by ourselves, but I believe that
our patients will side with us if they can be made aware how poorly some
insurance plans are treating us (while steadily raising patient premiums). If
patients are given the facts, then they and their employer's insurance
committees will be in a much better position to make intelligent choices when
weighing the merits of good and bad insurance plans.
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HOW TO GET THE MOST
FROM THIS WEB SITE
I have been adding to this site regularly
for many months; and it has grown quite large, maybe even overwhelming to
some if not approached correctly. In order to obtain the full value of the
site, I suggest the following approach:
- Read
each of the Main Topic pages headings (listed at the top of every
page) thoroughly and in order (i.e., "Introduction",
"Introduction for Doctors", "Doctors are the Good
Guys", etc.)
- Feel
free to explore any of the links as you go, but always come back to
the Main Topic page you left until you have completed that entire
page. If you do not do this, you may "get lost" in the links
and miss a great deal of valuable material.
- Resist
the temptation to jump ahead and explore the "Latest Bad News"
pages until after you have thoroughly absorbed the contents of the Main
Topic pages; since these pages lay the groundwork for understanding the
rest of the site.
- Finally, work your way chronologically through
all the "Latest Bad News" pages as these are all filled with
valuable information, reimbursement data, and links. At the bottom
of each "Bad News" page you will see PLEASE DON'T STOP and a place to click
to access the Master Site Index which will take you directly to many
points of special interest.
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