Consumer Directed Healthcare

By CARLA K. JOHNSON, Associated Press Writer

CHICAGO - Some health insurance companies rate doctors on their performance. Now doctors are turning the tables.
The American Medical Association issued its first health insurance report card at the group’s annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid.

“Physicians are spending 14 percent of their total revenue to simply obtain what they’ve earned,” said Dr. William Dolan, an AMA board member.

The report card is an effort to reduce the cost of claims processing to doctors and help them as they negotiate contracts with insurance companies, he said. The report card will help patients if it reduces wasteful administrative costs, Dolan added.

The report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. It is based on a random sample drawn from 3 million claims.

There are no grades like A, B and C, and many of the technical measures may not mean much to most patients. But business leaders and health policy makers are interested in cutting an estimated annual $210 billion in wasted administrative claims processing costs, AMA leaders said.

Four years ago, Dr. Marcy Zwelling got so frustrated with the time and cost of making sure she was paid accurately by insurers that she stopped dealing with them. She now runs a so-called “boutique” practice. Most of her patients pay her an annual fee out of their own pockets.

“The best thing is, I get to be a doctor” instead of a claims processor, said Zwelling, of Los Alamitos, Calif. She says she doesn’t make any more money than she did when she accepted insurance, but she has more time with patients.

UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.

UnitedHealthcare spokesman Gregory Thompson said doctors and their billing services share responsibility for prompt payment. “Data show there is often a significant lag time between when services are provided and physician claims are submitted,” he said.

He said UnitedHealthcare has improved its electronic claims systems and noted the AMA gave the company higher ratings on other measures.

Medicare performed better than the private insurers in most areas, said Dr. Lawrence Casalino, a University of Chicago health economist and former physician. Commercial insurance plans compete by promising employers that they are tough on holding down the cost of claims, he said.

“There’s no question that administrative costs for doctors and the country would be a lot lower in a single-payer system,” Casalino said in an interview after the meeting. But a market-based system has advantages of competition, choice and innovation, he said. “Are the benefits enough to justify the cost?”

Peter Lee of the Pacific Business Group on Health welcomed the report card, but said he hoped the AMA would look at a broader range of areas that would be helpful to consumers.

“Increased payments to physicians means increased premiums and increased costs in a system that is spiraling out of control,” Lee said.

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said that for claims to be processed accurately and quickly it takes two parties: insurers and doctors.

She complained that while insurance companies that rate doctors generally share the information with doctors before they make it public, the AMA did not share its report with insurers before releasing it online Monday.

In other action Monday:

• The delegates voted to lobby for legislative changes that would allow pilot studies to find out if offering financial incentives would increase the number of organs available for transplant from deceased donors. According to the AMA resolution, pilot studies involving payment are barred under the National Organ Transplantation Act.

• Delegates took a step back from endorsing programs that use undercover patients to evaluate the performance of doctors and their staffs. The delegates sent the matter back to the AMA ethics council. Doctors were concerned that these sham patients, used by some hospitals and clinics to evaluate health care performance, take time away from real patients.

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Report Card: http://www.ama-assn.org/go/cureforclaims

By RAHUL K. PARIKH, M.D.
Published: June 10, 2008

It wasn’t the boy I had a problem with. It was his mother.
 
We had met a few months earlier, when I gave her 14-year-old son a diagnosis of mild asthma. I didn’t mind her tough questions, but her tone of voice put me on edge. She seemed suspicious, almost angry. Still, in the end I decided she was just a smart, assertive parent, and I let it go.
 
This time, she was more confrontational. She complained she had been “forced” to bring in her son for a physical because his school needed a doctor’s clearance before he could play sports. What kind of racket did we doctors have with schools? Why did she have to bring in her son when she knew he was healthy? I was taking her money for doing this?

I bit my tongue and tried to tell her why I thought they belonged here. Yes, he was probably very healthy. But an annual checkup could help him learn to take charge of his own health as he grew up, and it would give me a chance to encourage healthy choices and to get a good sense his emotional health during these challenging years. Finally, I pointed out, he was due for a tetanus booster.

She was unimpressed. “I don’t believe in preventive care,” she said. “I’ll treat him for tetanus if he needs it.”

The rest of the visit went more smoothly, mainly because Mom left the room so I could examine her son. But before they left, she again accused me of taking her money, saying I hadn’t done anything different from their previous visits. Before I could reply, her son politely confirmed that this visit had been more comprehensive.

I have had my share of difficult patients and parents. But putting up with this lady had taken more time than it was worth, and it interfered with my taking care of her son. I wasn’t sure I wanted to do it again.

I considered my options. I could be stoic, do my job and keep the boy in my practice. I could call his mother and ask her to keep her opinions to herself so I could focus on her son, though my instincts told me that this wouldn’t stop her. Finally, I could decline to see her son, and therefore her, ever again. In other words, fire my patient.

The physician-patient compact basically states that a doctor will care for a patient in exchange for compensation and that the patient will heed the doctor’s advice. Patients who disagree with their physicians, or just dislike them, are free to go elsewhere.

By the same token, this mutual contract gives a doctor the right to dismiss a patient. The most obvious reasons are failing to pay or missing multiple appointments. Refusing to adhere to treatments can lead to dismissal. So can being abusive to the medical staff.

Of course, we need to exercise this option sensibly. Doctors cannot fire a patient in dire straits like severe pain, bleeding or a life-threatening situation. And of course, we cannot refuse to see patients because of their race, age, sexual orientation and so on.

But could I fire a patient because I didn’t like his mother? Colleagues who had studied the ethics and legal issues told me that the answer wasn’t clear-cut. Obviously, I couldn’t just abandon them. Yet like a lot of legal jargon, the word “abandonment” is open to interpretation. I decided it meant that as long as I wasn’t leaving anyone out to dry with a serious, immediate medical problem, that I gave a patient reasonable notice and provided options about where to continue getting care, I was within my rights.

I thought about our conversation on the tetanus booster, when the mother said she didn’t believe in preventive care. I’m a pediatrician — prevention is in my DNA. If I accepted her view, I’d be compromising my conscience and my professional ethics. I couldn’t do that.

I wrote a letter addressed to my patient’s mother and sent by certified mail. I kept it brief: “Sometimes, a patient or family and doctor aren’t compatible. … Therefore, I will be dismissing you from my practice.” I went on to advise them how they could get a new pediatrician and told them that until they found a new doctor, I would continue to care for her child’s mild asthma.

Two weeks later, I received notice that they had gotten it. The child had signed for it, which made me feel bad because I didn’t have anything against him. Checking his chart, I saw that his mother had chosen a new pediatrician, a colleague of mine. They hadn’t seen him yet.

I considered telling my colleague about my experience. Perhaps warning him so he could remember to take extra care would help get them off to a better start. On the other hand, perhaps I would unfairly bias him against this child and his mother.

I decided to keep quiet. After all, it could have just been me. 

Rahul K. Parikh is a physician in Walnut Creek, Calif. He writes about medicine for Salon.

 

Check other readers comments:  http://community.nytimes.com/article/comments/2008/06/10/health/views/10case.html

 

A story of battling cancer and battling hospital bills.

http://cosmos.bcst.yahoo.com/up/player/popup/?rn=3906861&cl=8111503&ch=4226723&src=news

WHERE CAN I GET THE BEST PRICES ON PRESCRIPTION DRUGS?

 

 

First of all, whether you are 25, 45 or over 65, prescription costs can be a bear. Some carriers won’t cover certain drugs, some drugs haven’t been in wide spread use long enough to be approved by various carriers, some are excluded due to sheer cost….. but there is help!

 

There are many avenues to saving money if you don’t have a health plan that covers your particular medication needs - or if you don’t have a plan at all.

 

First….. doctor’s samples. Almost every prescription that a doctor can write has been given to him in sample form, by pharmaceutical reps. If nothing else, a doctor should be able to give you a two week to two month supply of samples. Some doctors have kept patients going indefinitely on samples.

 

Second….. ask if the prescription comes in a generic form. It is surprising how many doctors just write out the prescription for the brand name, even when there is a generic.

 

Third….. if you take a medication that is in a breakable tablet form, ask your doctor to write it for double your usual strength with the instructions to break it in half. The price difference between 20 and 40mgs of a drug is often less than 20%. Sometimes, there is no difference.

 

Fourth….. shop around! Many of the stores have those wonderful $4 generics. For the most part, the least expensive retail store I have seen for brand name is Costco. Go to www.costco.com and check out any of your prescriptions - you may be surprised by some of those rates.

 

Fifth….. I have never heard a horror story about prescriptions filled in Mexico but, since those factories are simply independently contracted and Canada’s are owned and operated by many of the manufacturer’s themselves, I would tend to trust Canada more…

 

Sixth….. Canadian mail order. For some reason, some folks think this isn’t around anymore. The only ones complaining about Canadian mail order are all the “middle men” involved in the distribution of prescription drugs who won’t get their “cut” if you buy your prescription outside the US. By the time a medication leaves the factory and gets to your drug store, it goes through about six distribution points, each with their own fee tacked on. Try www.candrugstore.com. Once on this very easy-to-use website, use Promo Code 898 and your first order will get free shipping, even if you have ordered in the past. Or call 866-444-6376 to place your order - again, reference Promo Code 898. Note: they do not, never have and never will order from China due to quality control issues.

 

Also, the patent on brand name drugs is only good in the US. Many of the same companies who

manufacture prescription drugs in the US make them in Canada also -  in their own facilities and

in a generic form. This is true - and the cost, ordering through Canada, is anywhere from 35% to

75% less the cost of the brand name equivalent.

 

Seventh….. if you are low income or simply have some really costly meds, you can contact the manufacturer directly and ask if they participate in any prescription assistance programs. Many do and none advertise this. All it takes is for you and your doctor to fill out a form and send it in. Many drugs costing in the $75 to $300 range are dispensed at little or no charge by the manufacturers.

 

Bear in mind, too, that many brand name and some generics, are manufactured in China, regardless of where you are buying them. There have been some recalls of prescription drugs manufactured in China that contain heparin. The Internet is a valuable tool is keeping up with this type of information. 

 

The above tips are for everyone - not just the over-65, the unemployed, the disabled…. everyone.