Sunday, June 3, 2012
The face of medicine in the United States is about to change dramatically. For many years now, individuals have had choices regarding their healthcare insurance, they could choose an HMO plan or a plan that offered out-of-network benefits. The HMO plan requires subscribers to use contracted physicians who are "in plan" or else you have to pay the full doctor's fee yourself. With a PPO plan, one that offers out-of-network benefits you can choose to see a physician who does not contract with the insurance company. The insurance company will pay 70-80% of the usual customary fee for the doctor's services and you will be responsible for the 30-40% difference. You can always still use an "in network" physician to have 90-100% of the fee covered. You have the choice of paying a bit more for the opportunity to be cared for by a non-participating doctor who you may prefer. When insurance companies base their out-of-network reimbursements on usual and customary rates then not only do consumers have choice but physicians have a choice whether to be in-network or out-of-network. This means that insurance companies have to negotiate rates that some physicians will consider acceptable because those physicians otherwise can decide to stay out-of-network. This helps maintains a free market model in medicine, choices for the consumers and choices for the providers. This model is on the verge of changing profoundly. Health insurance companies want to peg out-of-network reimbursement to medicare rates. Physicians, especially surgeons and other proceduralists, can not remain in private practice with reimbursements based on 140-200% of medicare. Private practice physicians will go out-of-business and be forced to either leave medicine or become an employee of a large medical group or hospital. Only a small handful of physicians will remain in private practice and patients who choose to have these physicians care for them will have to pay the lion's share of that doctor's fee out-of-pocket. Those who can afford to do so will still have a choice, the remainder won't so this will immediately create a two-tier medical system. Once the majority of physicians are driven into large groups and hospitals that contract on behalf of the doctors, the insurance companies will ratchet down the reimbursements because physicians will have no option left but to accept whatever payment is offered. The large medical groups and hospitals will, of course, limit the number of physicians they employ to provide enough income for the physicians in their group. In order to make a marginally adequate income these health-care providers will have to see a very high volume of patients. This all translates into long waits for patients and very short visits. The quality you expect just won't be there. The coup de grace is that these clearly inferior insurance policies are still costing the consumers more, the insurance companies aren't lowering the cost of these plans, they are raising them. Make no mistake about it, the money that does not stay in your pocket or go to your health-care providers goes into the pockets of the executives of the health insurance companies and then to the company's shareholders. So if you care more about your investment then your health-care, buy stock in the health insurance companies. If you care more about your health-care, contact your legislators and insist that the private practice of medicine be allowed to flourish in the United States.