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The primary care salary discrepancies mentioned in "Where do you stand on the pay scale?" [March 19] don't bother me too much. In fact, I wouldn't complain about my pay at all if I could just get paid!
The hoops we have to jump through to justify reimbursement seem to get smaller and smaller. We don't get paid if we so much as neglect a modifier or make an honest error. I've had insurers wait six months before telling me that they needed more information on a routine procedure.
Debbie Heck, MDMuncie, INDocDebbee@yahoo.com
Many thanks to Anne Finger for "Want to boost revenue? Mount a collections campaign" [March 19]. It covers the many tasks I go through daily to maximize doctors' return on investment. As a practice management consultant, I know very well the need that doctors have for individuals as astute as Margaret Jackson to help them with accounts receivable and unpaid claims.
Re: Ken Terry's description of the possible restructuring of employer-based health insurance, "Defined contribution: Should you be afraid?" [online exclusive, March 5]. As a market researcher, I'm not suggesting that the sole fix for health care is defined contribution. (Instead of offering employees a health benefits package, employers would provide a certain amount of moneya defined contributionthat employees could use to buy insurance or pay directly for their health care.) But it's a step in the right direction. Be afraidof what? Of having my employer decide where I can get my health care? Or are you talking about going to visit a doctor and not having information about his fees, qualifications, and past experience/success rates readily availableinformation that would exist if consumers were making their own decisions?
While I'm a staunch advocate of the defined-contribution approach, I appreciate the concerns you raised.
To the extent DC is being offered as a panacea, Terry's points are well taken. DC will not bring back the medical profession's days of milk and honey. Indeed, the idea of competing on the basis of price and quality (read "value") is frightening for many physicians.
DC does, however, begin to straighten out the economics of health care, which have been distorted over the past 50 years. If combined with other measureslike a rational tax policy, less state regulation, and access to better information for consumersDC could create a dynamic, innovative, and fluid health system. Such a system would feature ongoing market-driven improvements, rather than the clumsy efforts of the politically controlled system we have today.
Senior Fellow in Health Policy
National Center for Policy Analysis
As a health care actuary with 25 years of experience, I see several reasons why defined contributions would cause physicians to sing the blues.
For any provider or employer about to take on the myriad of issues that are currently handled by insurers, I offer best wishes and a caution to proceed only with the advice of an actuary who is an expert in health care issues.
Joan P. OgdenSalt Lake CityJPOgden@Xmission.com
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Gail Weiss. Letters to the Editors. Medical Economics 2001;10:11.