Solution-#4: Physician Fees
Physicians, hospitals and ancillary services (radiology, laboratory and medical supply firms) generally receive checks from an HMO amounting to 30 to 50% of what they actually bill. Thus, it stands to reason that they are currently living on that 30 to 50%. At APR we are going to contact every county medical society in Ohio and request three things of our state’s fine physicians:
#1. Since the HMOs will no longer be telling physicians how, when, where and why you treat their patients, only bill what you are now receiving in remuneration from an insurance company’s HMO.
#2. Publish a full disclosure document that informs the public what you are charging for your various services. That would include routine office calls, complete physical examinations, EKGs, endoscopies, immunizations, etc. By doing that the market will control the price and people can shop for the best physicians at the lowest cost to their health savings account. It’s what is called free enterprise. Free enterprise, by definition, implies business governed by the laws of supply and demand, not restrained by government interference, regulation or subsidy; also called the free market. In healthcare the demand side represents the patient and the supply side represents the physicians. This is simple economics 101
#3. Since many physicians actually lose money in caring for Medicaid patients, some of you have chosen not to accept those people into your practice. We would ask that you physicians refer them to a community healthcare facility (a clinic for the uninsured or indigent that will be discussed in a future article.) ER personnel will likewise be advised to refer their non-emergency cases to the clinic or a physician’s office the following day.
By eliminating the HMO we will have also eliminated a great deal of unnecessary paper work and oversight that has taken up much of the time that the physician’s clerical staff has spent processing forms and preparing for on site visits by HMO nurses. For example, an HMO would call my office and request the staff to sanitize five of the charts of our patients (their clients) currently under their control. To sanitize the chart my staff would have to copy every document that had the patient’s identifying information and black out the name, address, etc. Then the HMO’s nurse would review those records to see if I was in compliance with their standards of care. One of those so called “standards” involved initialing every consultation, laboratory and radiology report. I chose not to do so, but instead preferred to follow up on such information with appropriate actions. I was cited and reprimanded by the CEO of one HMO for not complying with the inane rule to initial. Had that nurse followed up on her surveillance by looking at further laboratory or radiology reports and my office notes, she would have seen that even though I had not initialed the reports, I had responded properly on the information I had received. One such case involved a chest X-ray that I had ordered on a diabetic smoker with a chronic cough. The report described a suspicious lesion in the left lung and recommended a CT. I did not initial the report but instead called the patient telling him about the suspicious lesion and then ordered a CT scan of his chest. That showed signs that were very convincing for a cancer. I did not initial that CT report either but I did call the patient and asked which thoracic surgeon he preferred. I then spoke personally with the surgeon. When the patient was admitted for surgery I followed him for his diabetes. I did not initial the reports from the hospital but attended to them on a daily basis. When the cancer was removed I set the patient up with an oncologist. These steps were all well documented in the file and every step performed apart from the useless initial.