Dear HMO,
As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs. Unfortunately, this is not the case for many Americans. Most importantly, I know to avoid signing up for certain health maintenance organizations (HMOs). Although I am a strong believer in the fact that everyone deserves access to affordable health care, I am quite perplexed about your way of delivering it.
Throughout my many years of medical training, we were never taught much about insurances, billing, and reimbursement. Our focus was on patient care. As I sought to open my own practice, I had to learn these things on my own. So, I researched and signed up for nearly every insurance plan possible. The details of reimbursement were very vague for most of the various insurers, but I wasn’t prepared for your method of reimbursement.
Shortly after graduation, I established myself as a new physician at my own practice. I open up my mail one day, and I find a check sent from your HMO. Curiously, I’ve received a bonus check for every patient who had obtained certain health maintenance screening exams like mammograms, pap smears, colonoscopies, or flu shots. Not only that, the letter lists the names of people who have not had their health screenings and tells me basically, “Hey, if you can get these remaining patients to get their scheduled health maintenance exams then you will have more bonus money waiting for you!”
I’m wondering why don’t you give this bonus money to the actual patient who followed through with my recommendations and let them benefit from taking a proactive approach to their own health? Send them a letter stating, “Get your screening exam and get $20!”
I am passionate about preventative care, and I encourage all of my patients to have their appropriate health screenings. But as a physician, I can only lead a patient to the mammography or colonoscopy suite; I cannot force them to get their screening exams.
OK, so I know you’re probably thinking: If I’m such an altruistic doctor, why don’t I just give the patients the bonus money myself? Well, because I can’t. It violates my contracts with you, and I can be banned from accepting your insurance if I waive co-pays, refuse to accept deductibles, or gift patients monetary rewards that were given to me.
Or why don’t I just stop accepting your HMO entirely like many of my colleagues? Well, I must admit that I have thought about it. But, then I think about my patients, my family, Mrs. Smith, Mr. & Mrs. Jones, Rev. Miller, and I don’t want to abandon them. It’s not their fault that they are stuck with your HMO insurance plan.
My staff has taken some of our patients to their colonoscopy or other health screening appointments. Why? Well, not because we really needed the extra few dollars that it would get me. But simply because my patients are my family; I’m an advocate of health screenings and preventative medicine; and I do not believe that anyone should be refused the right to obtain their appropriate health screenings simply because they do not have a friend, neighbor, or loved one who is able to drive them to and from their screening exams.
Maybe you feel like if doctors aren’t rewarded for getting patients to stay current with their screening exams, then no doctors will do so. But, most physicians spend 8 to 15 years of post-graduate training and incur over a quarter of a million dollars of loan debt because they are committed to their health careers and the best interests of their patients. Pay us a fair reimbursement for providing care for our patients. If you feel like some physicians need extra monetary incentive, then split the incentive. Give the doctor 10 percent for ordering the exam and the patient 90 percent for actually getting it done.
Do I have to do my part as a doctor to educate patients on the importance of such health screening exams? Certainly. But, my motivation to do so is not solely for financial gain. I became a physician to help people. And yes, I deserve fair and appropriate compensation for doing so, and as such, I also feel like my patients who are wise enough to listen to my advice should also be rewarded.
Victoria Dooley is a family physician and can be reached at Northville-Novi Family Medicine.
Image credit: Shutterstock.com
