Text 20826, 104 rader
Skriven 2006-06-27 17:00:30 av Alan Hess
Ärende: insurance cuts
======================
There definitely seems to be a problem with insurance (private and public)
reimbursements to doctors.  Overcrowded emergency rooms are also a big problem.
 How can these problems be addressed?
***********


http://www.baltimoresun.com/news/opinion/oped/bal-op.medical27jun27,0,4035919. 
story?coll=bal-pe-opinion

From the Baltimore Sun
Insurers' cuts to providers threaten health care


By George H. A. Bone

June 27, 2006

For years, doctors have been warning that our health care delivery system is
being damaged by health insurers' strategy of cutting payments to physicians
and other health care providers to control costs. The evidence is becoming
clear that the damage is real and its consequences affect everyone who needs
medical care.

Whether you're talking about a nonprofit hospital or a for-profit physician
practice, a simple maxim prevails - no margin, no mission. Payment cuts by
health insurers and Medicare have produced far more than a reduction in health
care providers' profit margins; they have cut deeply into the ability of our
delivery system to meet the needs of our communities.

But don't just take doctors' word for it. This month, no less an authority than
the National Academy of Sciences' Institute of Medicine made this point, among
many, in a set of three reports about an urgent crisis in our nation's
emergency departments. The reports gained wide media coverage, mainly for their
top-line conclusion that our emergency departments are stretched to the
breaking point by an inadequate capacity to meet surging demand for emergency
care.

Less noticed by the media was the institute's explanation of how things got to
this point. Despite soaring demand for emergency services because of older and
sicker patients (many of them uninsured), from 1993 to 2003, the United States
"experienced a net loss of 703 hospitals, 198,000 hospital beds and 425
hospital EDs, mainly in response to cost-cutting measures and lower
reimbursements by managed care, Medicare and other payors."

In short, managed care's strategy of cutting provider payment has taken us to a
dead end.

The crisis in emergency care is just the beginning; primary care is in an
equally precarious condition. The American College of Physicians this year
issued two policy reports describing an impending "collapse of primary care
medicine" because of a shrinking pool of primary care physicians at a time when
an older and sicker population demands ever more of their services.

It's not a pretty picture, yet in Maryland and Washington, CareFirst BlueCross
BlueShield has announced a new round of physician payment cuts effective
Saturday in order to match UnitedHealth Group's low payment rates. CareFirst
and UnitedHealth dominate the Maryland and Washington insurance market,
charging ever-higher rates to customers while paying health care providers at
unsustainably low rates.

Doctors aren't alone in thinking that something's wrong when UnitedHealth's
customers can't afford what the company charges in premiums and doctors can't
stay in business on what it pays in reimbursements. Yet its stockholders are
happy and the company's CEO got paid $1.6 billion in stock options.

Physicians are responding to CareFirst's unilateral payment cuts. Among the
reactions of those who have advised the Maryland State Medical Society, or
MedChi, of their plans:

? A practice of family physicians, which would take a hit from CareFirst of
$20,000 per doctor, will drop all its health plans.

? A pediatric practice, which would suffer a 42 percent cut from CareFirst,
also will stop participating in health plans.

That's in addition to the scores of physicians who told MedChi last year that
they had stopped providing on-call coverage in emergency departments because of
soaring malpractice costs and the likelihood that they will be paid nothing for
their work in the ER.

This is what reduced access to care looks like: inability to find a primary
care physician and a strong possibility that when you go the emergency room,
there won't be a surgeon or other specialist there to help you.

When you reach a dead end, you have to turn around and find another way.
Maryland physicians believe that what's needed most is leadership, especially
from employers, but also from government, the faith community, education, labor
and even families.

We believe this requires a coalition of top leaders across all levels of
society to make it a genuine priority to improve basic health, such as blood
pressure and weight, for everyone - not because it's the right thing to do, but
because it's just good business.

Doctors are reaching out to employers and others, asking them to do this with
us. Will they reach back?

Dr. George H. A. Bone is president of MedChi, the Maryland State Medical
Society. His e-mail is gbone@medchi.org.

Copyright + 2006, The Baltimore Sun | Get Sun home delivery

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