Friday, March 25, 2016

Family Medicine: Quality Suppressed by Insurance Companies- Costs of Care Driven Up

I got another threatening letter from an insurance company.  I have thirty percent more long visits than my peers.  Since I didn't align with what my peers do, they are threatening to audit me.  How do you insured folks feel about your insurance company pressuring your Family Physician to do less (or at least to code at a lower cost to them)?  With all the guidelines and other quality initiatives inflicted on Family Physicians in recent years, one should only expect that the level of service would go up and the charges would go up.  But no, they want them to remain the same.  Unfortunately, the majority of FP's undercode their visits for a wide variety of reasons.  Self esteem is a big one.  Training is another one.  Afraid of the insurance companies is another one.

I used to think that pressuring a whole group to do the same financial thing with their business was price fixing and would be outlawed by the Federal Trade Commission.  I guess that's not true.

Employers have no idea that the physicians caring for their employees are being pressured by the insurance company to do less, allowing their employees to be referred to more subspecialists because the physician held down the level of service at the primary care level and sent it up to the more expensive level.  The insurance company is forcing the costs up and driving the premiums up.


What do you think?

1 comment:

  1. Hi Dr. Jonas. This is a very good article.

    If you are getting threatening letters from insurance companies, you should get a lawyer. These letters can be considered harassment in court.

    I am insured (reluctantly) but am totally aware of the harassing my wall street loving insurer does to my internist constantly. In 2008, I was kicked off the roll when my insurer found out that my internist gives me a yearly physical. My insurer said prevention was actually "bad for their profits". Luckily for me, I was helping to draft major healthcare reform legislation (PL 111-148 and PL 111-152) in Congress and was able to get back on the rolls when I of course told my congressional physician bosses (yes physicians are in congress) what had happened.

    Insurance companies are completely responsible for the rises in premiums and for the downturn in quality of care provided.

    If you are concerned about harassment from insurance companies, have you not considered kicking insurance out of your practice entirely? It is easy to do and it is also 100% legal under PL 111-148. Here in TN, I recently drafted legislation that will allow for physicians to completely kick out insurance from their practices as well as keep away any dealings with the State Dept of Insurance. My bill was passed by the Senate 32-0 and it is now heading to the House where it is expected to pass. Once my bill is in place, TN physicians will finally be free of having to be harassed by wall street loving insurers.