In response to “Physicians want collaboration not complications from payers” (First Take, March 25), it is possible that physicians and payers can form a collaborative relationship, as hoped for. But it is highly improbable.
Why? Because they live in two different universes and are pulled by two different gravitational fields.
Payers are pulled by shareholders’ interests. Doctors are pulled by patients’. The two are incompatible. To make them work would require a whole new approach to healthcare, one that minimizes the profit motive of payers and maximizes the benefits to patients.
But, our capitalistic system would not allow it. Healthcare is better off in the hands of our government. This would make our elected officials accountable to voters.
Right now, payers run their businesses like fiefdoms, giving doctors and patients little say in how they are treated. Despite their complaints about the costs of doing business, insurers’ make good profits every year and their CEOs make some of the highest CEO salaries in the business world.
Perhaps the time has come to talk about Medicare for all. It works for the elderly and it could work for everyone. It would take lots of work and compromise but it is the best way to have health system that is accountable to voters.
Edward Volpintesta, MD
This is why there is a primary care shortage
In response to “Can anything be done to solve the PCP shortage crisis” (MedicalEconomics.com, April 24, 2017), ultimately what is driving physicians out of primary care is the failure to reimburse primary care physicians for the large amount of time they spend getting patients the medicines they need by completing insurance forms.
Failing to reimburse primary care physicians for the time they spend addressing abnormal tests by reaching out to patients who are not sick enough to require a second visit to the physician office but whose labs and other tests are often abnormal. Primary care physicians also are losing their lowest cost of care patients with simple, treatable illnesses to less trained providers who are competent enough to care adequately for the majority of these easier patients.
Meanwhile, the primary care physicians see their schedules increasingly filled with more complex patients with multiple medical problems, all of which must be considered together to provide optimum and some would say adequate care.
Coupled with the high expense of providing multiple un-reimbursed free advice services for many patients, primary care physicians still carry much higher liability risk than nurse practitioners and physician assistants. Furthermore, most of the data tracking that is being required by government and insurance programs falls exclusively or primarily on primary care physicians further increasing their overhead expenses.
Despite the promise that quality would be reimbursed, programs in place do not guarantee proportional increased payments for the many additional hours of work and overhead staff costs to document the quality of care provided.
Finally, even though working more hours to provide more documentation and working less desirable hours to provide more access to patients at off hours, primary care physicians are often paid one-third or half of what their subspecialty colleagues make in salary and are also prevented by federal law from investing in imaging facilities, labs, ASCs and hospitals where they refer their patients.
The recommendations in the article “8 ways to make adult vaccinations profitable” (Medical Economics, March 10, 2017) are perhaps more suited to group practices where losses do not fall on one or two individuals.
I am a great proponent of vaccines for all age groups and because of that reason, I have been suffering financially precisely because of my passion about the benefits of vaccinations.
One of the major insurers in New York paid me $0 for Meningococcal B vaccine, and after a few months started paying $58. The vaccine cost through a purchasing group is $131.
Other prominent insurers are not far behind. Some pay me $50 for Menatcra, $44 for Pneumo 23, and $44 for RotaTeq. Needless to say, these numbers are far below the purchasing costs.
Larger group practices negotiate costs, but individuals in one- to three-physician practices cannot.
The fact the same insurance company would pay different groups of doctors reimbursement ranging from 80% to 140% (I have heard a 300% number also) for office visits is almost fraudulent.
It is easy to talk about vaccines, but when a patient comes, it can take up to 20-30 minutes to find out if the vaccine is covered. One might argue that an office can have this info beforehand, but it keeps changing, and moreover the same insurance may have hundreds of “sub-plans” with different benefits.
We need to have a national dialogue to mandate insurance companies to pay a fair amount for vaccines.
Anil Gupta, MD
Bronx, New York