Thursday, January 08, 2009

C’mon, Man Part Two

In a previous post I came down hard on Charter Internal Medicine for the way they handled their decision to reverse course on transforming to a concierge type medical practice. In early December Charter announced that it was bowing to pressure from state regulators and reversing course. Patients of Charter first learned of this change of course by reading about it in the paper. As a Charter patient I did not receive any communication from them about this change until January 2nd.

Last week I had an appointment with my Charter doctor. I told him I thought it was handled poorly from their end and he apologized. He told me that they were faced with a quick decision to challenge the state or to comply. The potential for a large legal expense to fight it discouraged them from the challenge.

I have worked with other doctors in Howard County who have transitioned their practices from the insurance reimbursement model to the retainer model without any interference from the government. The difference between those practices and Charter is that they were small. With over 9,000 patients on its rolls, Charter was big enough to attract the regulators and politicians attention.

Of course this isn’t right. The government is effectively forcing the doctors to work with the insurance companies. The insurance companies have a very powerful lobby.

The result of all this is that the consumer (patient) is disconnected from the actual cost of healthcare. This is one of the fundamental problems with the cost of healthcare in this country as Dr. Mark Perry points out in this post on his Carpe Diem blog.

I still say “c’mon, man” but now I direct the comment to the Maryland Insurance Administration and politicians who are trying to stifle real healthcare reform.

C’mon, man!


Anonymous said...

Are you frustrated or what?
I wanted to respond and found that you were dealing with several issues for which comments would be appropriate. You blame the docs for their lack of sensitivity to their customers' needs in this incident. Let's give them the benefit of the doubt. They are overworked and understaffed. We have a 20% deficiency in primary care physicians and nurses in Maryland. Most of them were altruistic and wanted to do something beneficial for mankind and not become business people. Some wanted a nice income with perks. What they found were contracts reducing their per patient income but also huge increases in malpractice premiums which forced some OBGYN's to retire or go to another state. The sky's the limit in Maryland. Talk about lobbies, try to get malpractice reform through Annapolis with all the attorneys who are representing we average citizens. Arbitration and negligence caps like $250,000 are not going to pass in Annapolis or Congress because of the Attorneys Lobby.
Your suggestion that the Maryland Insurance Administration (MIA) is going to go after the larger practice vs the smaller practice is uninformed. They don't care whom they go after. Small guys are more succeptible to MIA action because they don't have the financial resources to hire attorneys at $250-1000 an hour.
Maryland has been trying real healthcare reform for years. The result is that we have more mandates than any other state in the USA.
If we deleted mental illness, the cost of insurance would drop 10%. If you buy a $1200 deductible HSA on your employers group medical plan, your monthly cost is going to drop about 25 to 30%. If you have a $250 deductible on your RX coverage, you can save another 10-15%. What do these deductibles mean? You're moving out of the copay arena and going back to catastrophic insurance which is the way it was in the good old days 15+ years ago before HMO's.
The insurance company issue vs government is something else to contemplate. The government currently runs Medicare which has a lower reimbursement than insurance company contracts. Is it answer? It has a deductible with coinsurance for the patient. Some people find a need to purchase supplemental medicare to cover the out of pocket expenses. The government RX plan covers up front and end with a donut hole in the middle. Even government has to consider costs or guess what... we have to pay additional taxes.
Are there any easy answers?
I don't think so. So don't be so hard on your docs and next election vote for a public servant who has some great reform ideas and doesn't belong to the attorney's lobby.

Anonymous said...

Insurance companies have been an unmitigated disaster for the quality of health care in the US. People leave the US to get treatment - used to be the other way around.

These companies have the potential to make tremendous profits but instead spend precipitously and carelessly (440k junket on the taxpayers tab). The culture is one of superiority and graft.

And topping it off, they actually argue with patients over changing doctor prescribed medications - attempting to not cover one, but covering something similar. (yeah, happened to me).

Outrageous gluttonous ins co power drove Doctors to concierge, helped by the constraint on training additional medical personnel.

Lots of blame to go around, but as long as the ins lobby has a choke-hold on the major powers in Annapolis, there is no solution.