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The Stupid Insurance Companies Continue to Undermine Primary Care

April 23, 2011
A colleague in private practice, Dr. S of Plano, TX, sent me the following note he gave me permission to share:

Since the beginning of 2011, we’ve observed a disturbing trend among our patients’ new insurance plans.

At least two major payors (Aetna and Cigna) are now offering $0 or reduced copays for retail mini-clinics.
This means our patients are now financially incentivized not only to bypass the ER, but now also their own primary-care physician.

You already understand the impact this has on our business… The easy visits are now routed away, and we get stuck with the time-consuming, complex encounters (which don’t typically reimburse as well per time-spent).
I don’t think I’d call this a quality of care issue. I find the retail clinics are usually conservative with their antibiotic use, and I usually agree with their diagnoses (except for the ear infections that magically disappear 12 hours later when I see the patient in my office…)
But this still fractures continuity, and greatly reduces our opportunity to catch all the other care we provide in visits (like keeping up with vaccines, health and depression screenings, etc…)
We thought we were losing business to these clinics because they¬†offered¬†expanded hours, but I now see that our patients are simply not calling us when they are sick. We offer same day appointments. We provide great care… compassionate care. But it’s cheaper for them to go to CVS than to see their own doctor. And that doesn’t seem right or good.

This is not right or good. An important mechanism explaining why family physicians provide better health at a lower cost is they develop an in-depth knowledge of their patients over time. While a trip to CVS for a bladder infection doesn’t seem like a big deal, it undermines the chance for the family physician-patient relationship to grow. The other sad truth exposed in Dr. S’s email was he once again reminds us that the current insurance company/RUC/Medicare coding, billing, and payment rules don’t pay family physicians for the complex work they do. The RUC approach allows ologists to overcharge for relatively simple single-body part visits, while the family physician is forced to give away his services when he cares for complex multi-symptom multi-organ multi-chronic disease patients.

I guess we shouldn’t be surprised that the for-profit insurance companies can’t see past next quarter’s balance sheet. It takes a bigger vision to understand the magic of family medicine.

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