Posts Tagged rates
Plastic surgery is not always as glamorous as you see on television. Part of my practice has been the repair of wounds. Recently a wound care hospital at which I have seen patients called asking if I would see a patient. The patient’s HMO pays at Medi-Cal rates. For those of you who don’t know, Medi-Cal is California’s Medicaid program.
Medi-Cal rates amount to about half of Medicare rates which is essentially nothing. The practice barely squeaks through any profit on most Medicare business. I am always conflicted as to whether or not to see such a patient.
On one hand, I’d like to be of help. On the other hand, starting a trend at which doctors care for patients at less than overhead is part of what brought us to where we are today.
John Di Saia MD
Originally posted 2011-04-27 07:30:57.
In 2005, Aetna issued a press release stating that the company would place online its fee schedule for provider physician services so that consumers could price shop.
The funny thing is that physicians have been asking for such a list for years with no response. The patients are the clients in health insurance. Physicians are vendors.
I am happy I am not an Aetna provider.
John Di Saia MD
The spike in medical malpractice awards that prompted an emergency session of the Maryland General Assembly last year has since faded, leading the state’s largest insurance carrier to hold the line on rates it will charge doctors next year. After two years of double-digit premium increases, the Medical Mutual Liability Insurance Society of Maryland attributed its decision to a significant drop in the money it is paying in malpractice cases. The announcement, made in a letter to policyholders this month, was greeted with skepticism by some trial lawyers, who argue that last year’s legislative exercise was a thinly veiled attempt to limit the money patients can receive when their doctors make errors.
Many of the usual malpractice insurance arguments are raised in this piece. Medical malpractice rates have gone up for two consecutive years by 28 and 33 percent in Maryland. Increases in other states have been smaller.
When a single company doubles its malpractice awards for a given year (2003), they need to refund the corpus of their accounts to pay for additional awards. They do this by increasing rates to the physicians under the plan.
There has been some legislation bandied about such as decreases in pain and suffering awards. The trial lawyers are fuming. They want their multiple million dollar per case fees to keep coming in. They say they are protecting their clients. Then agree to take less of the money. They can never seem to do that.
Here’s how the whole mess affects the consumer:
When overhead becomes unaffordable (including malpractice premiums), doctors limit their low paying insurance business. I have dumped all my HMOS. If you are an HMO patient, you can only see me as an emergency in the local emergency room (that is if you want your insurance to pay any of the bill). I have also dumped provider status for all the PPOs. This means patients pay more out of their own pockets to see me. Seeing as I am one of the few plastic surgeons doing any insurance business in my local area, this is more of a problem for the consumer than it is for me. I simply got tired of losing money.
Possibly worse is that patients with difficult problems with which liability is associated have a harder time finding doctors to care for them. Doctors start looking at some patients as potential sources of additional liability and rid themselves of such patients. Doctors in my local area “fire” patients when they refuse to follow recommendations mainly to limit their liability in caring for them. You didn’t see this happening as frequently in years gone by.
Even worse is the case in which doctors find “the grass is greener” in another state. Then they pick up and leave. Our local hospital is about to lose it’s third general surgeon in three years. This one has been in practice in the area for over ten years.
He is moving to Texas. He will see increased revenue and a better lifestyle from the day he arrives. The So Cal weather he might miss.
It is a very big issue when you need health care. You are going to see less care and pay more for it out of your own pocket unless something substantial is done.
John Di Saia MD