Posted 05/06/2012
You don’t see those billboards anymore, the ones advertising health insurance companies (HICs) with some form of this message: We don’t tell your physician how to practice medicine—we let your doctor take care of you.
I guess it was too cynical even for the HICs, an industry in much disfavor these days. Even they had to draw some sort of line about truth in advertising. Tell us how to practice? We doctors are micromanaged by them.
As you must know, every possible aspect of your health care has been entered into the information system of your own HIC and then shared with other HICs. With this data, HICs can track doctors’ billing patterns, lab tests ordered, prescriptions written, referrals made, and surgical procedures performed. And because every day there are virtually millions of physician-patient encounters, you may be curious to know how a HIC uses behavior modification to keep doctors in line with “acceptable standards.”
Those quotation marks are deliberate.
Unsurprisingly, so-called acceptable standards are geared to maximizing HIC profits, having absolutely nothing to do with physician performance or with you getting the best health care. Acceptable standards generally means short and efficient visits, few lab tests, cheapest generic drugs, and as few patients as possible admitted to the hospital. Your HIC also tracks those dreaded pre-existing conditions, and by blocking your access to future health insurance also maximizes its bottom line. But you knew that already.
Physician “outliers”
The key tactic HICs use for behavior modification of physician outliers (a HIC industry term describing doctors who don’t play by their rules) is to place hurdles in front of physicians that waste time on irrelevancies. Time is, for all of us, a precious commodity. HICs know this all too well and lay it out like this: Doc—if you don’t want to waste your time on the phone getting prior authorizations for brand-name drugs, writing letters to justify a lab test, or having to copy and fax your medical records for our review, just play it our way. We could make it simple and send Rocky over to break your kneecaps, but really that’s not necessary. Just follow our rules, we’ll leave your kneecaps alone, and you can spend more time with the wife and kids.
Having related this, let me tell you how I’ve been spending my mornings.
Each day I arrive in the office about 30 minutes early to write a letter to a HIC in response to a letter I received from them the day before. Most letters begin “We welcome the opportunity to be of service to you,” a phrase frightening enough to tighten anyone’s stomach. It seems the HIC wants “additional information,” a “narrative report,” “patient progress notes,” and so forth.
They want my reasons for ordering a specific test that, in this series of letter requests, measures food allergies. Testing patients for sensitivities to foods they’re eating is “out of the box” thinking to them, making me a dreaded outlier and their computers smoke.
Why would I–or any competent physician–want to know what foods his patients are allergic to?
If you’ve been following the health tips and remember the two-part article Toxic Food Syndrome, you could probably write this letter yourself. Perhaps in my own letter I’ll relate the story of:
- A patient who suffered through four utterly useless sinus surgeries over a period of ten years until she was found to be sensitive to dairy.
- A man diagnosed with Crohn’s Disease, which not only terrorized his immune system but for which he took a $5,000-monthly immune-modulating drug until he eliminated gluten from his diet and his Crohn’s mysteriously disappeared.
- The young woman with rheumatoid arthritis, or one with fibromyalgia, or with chronic fatigue, each of whom improved by eliminating “culprit” foods.
I suppose I could mention also how “outlier” thinking actually pays off for everyone, including the HIC. Certainly I make no claim that eliminating toxic foods is a cure-all, but really, I say to the HIC, “You’ve already forked over more than $200,000 in useless sinus surgeries. Why are you arguing with me about a test that costs less than $500?”
Well, I don’t put it quite that way. After all, the HICs do keep us doctors financially afloat.
Waste my time, delay honest payment
Understand that this letter-writing business is not simply a behavior-modifying time waster, but also a delaying tactic for the payment the HIC owes me and my staff. Not only are hours slipping away writing these interminable letters, but the dollar amount our practice is fairly owed for these tests keeps increasing.
I’m sure they hope I’ll eventually get the picture (oh, have I gotten the picture!), cry uncle, and stop ordering food allergy testing. Not a chance. They’ll have to send Rocky to get me to do that.
One other interesting point: I don’t think anyone at the HIC is actually reading the letters I write. After we’d sent off a stack of them, we called the phone number indicated on their inquiry letter. No one at this extension knew about the letters. Someone quite pleasant promised she’d call back, but no one ever has.
So I’ve lately taken to tucking little parenthetical messages in the middle of a paragraph. At first it was “Is anybody reading this?” and later, “If you’re reading this, call this phone number and receive a free Target Gift Certificate.”
So far, no one has claimed it.
So tomorrow morning, I’ll place my latte next to my laptop and compose yet another letter. The process takes about 20 minutes. Twenty irretrievable minutes, gone forever. Makes me want to call them, ask for Rocky, and just get it over with quickly.
Be well,
David Edelberg, MD