Good story to read about the survey which included Medicare and 3rd party insurers...as the article states Medicare may have graded a bit higher as on the whole, most were not holding Medicare to the same standards expected from the 3rd party payers...(article may require a subscription) BD
You couldn't make up stories like these:
Shane Avery, MD, is a family physician practicing solo in Scottsburg, Ind. Earlier this year, his practice received a contract from a major health insurer offering a fee schedule based on 120 percent of Medicare rates. "It sounded fair, and we were about to sign," Avery said, "but then we read further and found out it was based on 2004 Medicare rates." "We counteroffered with 120 percent of 2007 Medicare, and they told us they couldn't do that," Avery said. "It wasn't a tough decision for me to throw the contract in the trash."
Alan Falkoff, MD, a family physician practicing in Stamford, Conn., was recently contacted by a major health insurer's disease management program regarding his performance. The health plan had profiled several patients and identified one who was lacking "needed care" - an LDL screening for the previous 12 months and an A1C test for the previous 6 months. "The ridiculous thing is that the patient hasn't belonged to my practice for years. He has been in a persistent vegetative state in a nursing home for many years following an anoxic brain injury after coding for cardiorespiratory arrest," Falkoff said. "I don't even know if this guy is still alive, but apparently his statistics exist in my quality assessment."
A comprehensive AMA study of the health insurance market showed "unequivocally that physicians across the country have virtually no bargaining power with dominant health insurers and that those health insurers are in a position to exert monopsony power.
One California physician wrote: "Most of the PPOs have announced rates that are now 80 percent of Medicare. We were getting 130 percent of Medicare up until 2002, and in recent years they are paying less. ... We will not be in business by 2008 if this continues."
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