Do you know why you're waiting so long in the doctor's office?

Shrinking insurance reimbursements mean physicians need to see more patients to cover costs

By DR. JACK D’ANGELO
http://www.silive.com

Articles in the medical journals in the 1940s discussed the endless amounts of time patients had to wait to see doctors. Sixty years later, this is still a common lament, but the reasons have changed drastically and patients need to understand the challenges and the reasons for schedule delays.

While we all know the economics of healthcare financing is out of control, the average patient may not realize their local doctor is struggling to keep the practice viable.

How can that be when the waiting room is often overflowing with patients needing to see the doctor? The greatest reason at this time is the overwhelming and unwieldy practices of the insurance industry.

Over the last 20 years, your physician has shouldered many of the responsibilities of maneuvering through your health insurance. The office has assumed the burden of processing insurance claims, waiting endlessly for approvals for treatment, and dealing with diminishing payments for services.

The end result is that instead of needing just one employee to take care of the patient, the doctor now needs seven employees. Most of these employees are not healthcare providers, but rather the people who assist the patient to maneuver through their insurance maze.

MAINTAINING CASH FLOW

In addition, insurance companies often set up their own formula for reimbursement of services so that for a given office visit, the payment actually decreases from year to year. As the payment decreases for a given visit, the doctor needs to see more patients in order to maintain the cash flow in the office to pay the staff and the overhead.

If a doctor sees 25 patients a day, the first 15 visits are just covering his overhead expense. If a patient fails to keep an appointment, in spite of a confirmation, then the office finances will be decreased.

Therefore, the physician tries to see as many patients as he or she can during the day. This is overwhelming for the doctor, as well as the patients.

In spite of the increasing costs associated with employee expenses, increased staffing and medical malpractice premiums, the reimbursement continues to decrease.

Even Medicare — the federal plan for senior citizens — has a formula in place to consistently decrease physician reimbursement. This formula, known as the Sustainable Growth Rate (SGR), is designed to limit the number of physician visits. As the number of visits goes up each year, the physician fee for each visit is reduced.

Unfortunately, the doctor has no control over patient visits. The reasons why patients go to the doctor each year is driven by greater patient awareness of treatments, new technologies, a shift from inpatient to outpatient services and aging of the population.

While Medicare payments to hospitals are tied to the Medicare Economic Index, which measures the cost of providing patient care, physician fees have fallen far behind this index. At present, it is estimated that Medicare payments cover only about 65 percent of the actual cost of patient services.

It is further estimated that this present formula will result in about 26 percent of cuts in reimbursement over the next six years, while we experience a 20 percent increase in expenses. The end result is even more threatening as the other insurance carriers usually reduce their rates in reaction to Medicare payments.

Why do you need to know this? As taxpayers, you have the greatest say in the future of medicine and your physician needs your support in order to continue to be available for you.

This column is provided by the Richmond County Medical Society. Questions may be sent to the column in care of the Advance.
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