I am a Terrible Doctor; and I ’ m Proud of it

It’s that time again. As the year draws to a close, various insurance plans try to finish collecting data to calculate bonus payments as “incentives” for “Quality” care. The only problem is that, as I’ve written before, all of their “Quality” measures are in fact nothing but proxies for cost, most of which I have no control over. Back in the 1990s at the beginning of the Managed Care era, the model of the primary physician was that of gatekeeper. Twenty years later, the last vestiges of this model is the wretched “Referral,” a word which used to mean something but was co-opted by the insurance companies to become the magic key to unlock the door to specialty care. The original idea was that I could control where patients went; preferably to cheaper (sorry; more “cost-conscious”) places. Couple of problems with this: I have no idea how much any given doctor or group charges for any particular procedure, and even if I did, I have no control over their negotiations with the insurance plan. If a patient wants to go to Hospital A for their procedure, the idea is that I can save the insurance company money by steering them to (cheaper) Hospital B. Good luck with that! Oh, I still refer patients in the sense that I make specific recommendations about what doctors I think would best be able to help them, but the vast majority of the electronic referrals we put in for patients are basically self-referrals. Patie...
Source: Musings of a Dinosaur - Category: Primary Care Authors: Tags: Medical Source Type: blogs