Quite often something will strike me in a strange way. For example, a sign on a conference room wall stating “POST NO SIGNS ON THIS WALL” caused me to stop and chuckle. Reading a recent Explanation of Benefits (EOB) from my insurance carrier had a very different effect on me. There were the descriptions of various services rendered, lots of dollar signs, and the phrase “Provider’s Responsibility.” I have seen that term many times before and not given it any thought, but that day it struck me as profoundly wrong.
“Provider” means doctor. The doctor’s responsibility should be to provide competent, caring, cost-effective, and timely care to the patient. The doctor should not be responsible for paying for the care, too.
Several months ago I attended a town hall meeting with the state bureaucrat in charge of the Medicaid program. He stated in very clear terms that the state Medicaid program was broken and needed to be fixed. He went on to describe the new level of bureaucracy that was being added to ensure Medicaid patients’ access to primary care providers. The idea is to provide them with preventive health care and encouragement to change their lifestyles leading to improved health, decreased utilization of emergency rooms, and eventually the lowering of the cost of health care.
What he didn’t say was that someone had to pay for this additional layer of bureaucracy and the only place it could come from was the pockets of the providers. What he did say was that additional responsibility was being placed on the providers. The providers had the responsibility to extend their office hours including weekends to provide Medicaid patients with more convenient, less expensive health care alternatives to the emergency room.
When asked why the patients weren’t being asked to share some of the responsibility, he said that adding co-pays had been tried before but, ultimately, the patients knew they didn’t have to pay them and it would only result in an even lower reimbursement for the provider as the co-pay would be deducted from the total allowable reimbursement. A number of physicians in the audience pointed out that they had already extended their office hours but many patients still chose to go to the emergency rooms. After all, they didn’t have to pay for it.
I recall an editorial written by a non-physician a number of years ago about people who complained about the high cost of doctor bills and the excessive income of doctors. His recommendation, if you don’t want doctors to make so much money, don’t use them! Things really haven’t changed all that much except that today the statement would probably end with “don’t pay them!”
I know we still make a better-than-average living, but we have also made many sacrifices and our costs are going up just like every other business. The current political rhetoric about controlling the costs of health care can only mean one thing: decreased reimbursement. After all, the patients can’t be held responsible.