Re: New York Times article

[Guest guest]

That already happened to us. We were excluded from blue choice solutions which is a limited plan from blue cross. We are in blue cross. This is a cheaper plan which was adopted by our city for all city employees. Most doctors here see between 40-60 patients daily. We see average 12-15. They said compared to these other doctors in our area, we cost too much. I appealed pointing out the long term savings in better overall patient health. I explained that many doctors seeing that volume of patients just hand out meds and fail in the follow up, but the medicines were not their problem. I explained that we had a 17 year old patient that someone wanted to remove her thyroid. My husband was willing to wait and follow her. She would have gone through a very expensive surgery and require medication for the rest of her life. A year and a half later, she is O.K. and has not had

surgery. This is now a patient of theirs. I also pointed out that the minute someone appears with an earache, they do not automatically get antibiotics. We had 2 different patients last week who came to us on antibiotics after seeing another doctor,and both tested positive for flu. The list goes on. They said that we used more diagnostic tests and had more visits than others, and they only cared about their cost. The same week that my appeal was denied from them, another insurance company sent the results of a quality review that they had conducted. They found that for their patients in terms of lipids and A1C, only 14 area physicians met their standard of 90% and we had achieved 100%. I didn't feel so bad that the money hungry blue solutions rejected us because we refuse to sell out our patients. The other insurer gave us a very nice pay for performance bonus last year, and now their review was positive. The problem is

that it is a definite risk that we will start to be excluded from more plans based on their short term monetary goals. As more and more expenses are becoming patient responsibility, the insurance companies will only focus on their costs. Patient care be damned.barronmo wrote: There is a good article today in the New York Times about diabetescare specifically and chronic care in general. One point I found particularly interesting was the reaction frominsurance companies to groups or individuals that provide excellentdiabetes care. Apparently, anything that might attract more diabeticson to an insurance company's rolls is avoided. This includes benefitslike covering test strips or visits to the nutritionist. Unfortunately effective care by physicians may fall into the

samecategory. A solo physician set up to provide excellent chronic care mightattract too many diabetics and find him or herself dropped from aninsurance plan just like the endocrinologist mentioned in the article. I couldn't help thinking that the biggest hurdle to implementing theideals expressed on this listserv and elsewhere may be the businessmenwe have invited into our profession in the form of insurancecompanies. The day average American's could no longer afford to paytheir doctor out of their pocket was a sad day indeed. Wouldn't manythings be better if we went back to <1970 when 70% of Americans wereuninsured (and it wasn't such a big deal!). Barron, MDSt. Louis University Family Medicine Program