A Doctor’s Thoughts on Managed Care
The following is excerpted from a letter sent to patients by Dr. PETER WALDSTEIN, a Beverly Hills pediatrician:
In 20 years of private practice, I have spent much time reflecting on what quality means in medical care. Over the past years, I have watched a service-oriented profession adversely altered by market-driven reform. HMOs and integrated health care systems believe that they need to increase patient/consumer satisfaction and improve patient outcomes. These are crucial objectives, but in their drive to hold down costs, these systems have tied the hands of providers so that true quality care is often not possible. Our present industry-driven systems leave out the uninsured, coerce employers to purchase cut-rate, often inferior health care, and leave our elderly with a bleak Medicare future.
Five years ago, to accommodate my patients, I joined several PPOs (preferred provider organizations). Unfortunately, the result has been mounting paperwork, an unacceptable rate of reimbursement, and the virtual impossibility to follow up on each and every family. Due to the numerous financially tiered plans each insurance carrier has to offer, it is unrealistic for my office to be able to keep up with this perpetual paper nightmare. In addition, while my office follows the instructions to a T when filing your claims electronically through our computer system on a weekly basis, it has become the insurance carrier’s common practice to ignore these claims for months on end.
Insurance companies have manipulated and restricted my practice techniques and significantly eroded the art of medicine.
Although cost controls are essential, I need to feel I can provide the best medical care without burdensome restrictions. Patients need to walk away from a visit satisfied and carefully listened to. I want to feel that I was able to make a connection and comprehensively tend to patients’ needs. I want to provide innovative, quality, preventive care to my patients.
Insurance companies do not consider the importance of preventive medicine (i.e., vaccinations and lab tests). In addition, the cost of vaccinations and general medical overhead has increased tenfold over the past five years due to the malpractice issue, yet the insurance companies have never given the doctors a cost-of-living increase.
The most valuable possession one has is his or her child. I think I do a very good job of making myself available at all times of the day and night, but unfortunately I can no longer operate under the conditions the insurance companies have imposed. They are grossly unfair to the consumer (patient) and to the doctor.
In an attempt to recapture what is most satisfying about practicing medicine, I have decided to discontinue participation in (two insurance companies) effective Jan. 1.
I wish you all the best of health and look forward to continued years of quality, rewarding and satisfying medicine.
