I'm frustrated with the mess that the insurance approach to health care makes for both patients and providers. I have 'contracts' with many insurance companies. Each has their own approach to determine what they will pay me for an office visit. Medicare clearly calculates how a price is determined. It still leaves a huge gap since I am paid by volume as well as time. I can see twice as many patients and still meet the criteria for a specific payment. I don't want to herd patients through my office but quality time is reimbursed poorly.
I really don't know how private insurance companies decide the reimbursement rate. The reimbursement range is wide; the best-paying company reimburses 25% more for an office visit compared to the lowest-paying company, for the same level of care. the lower-paying insurance companies (and Medicare) say I need to be 'more efficient', which ends up meaning see more patients and spending less time with each patient.
I understand sales and volume discounts for mass-produced items and companies trying to increase business. I understand that a service-based business may offer a new customer discount or other sales promotion to increase business. Neither of these conditions apply to my medical practice. If I refuse to rush patients through my office and the insurance companies (and Medicare) refuse to pay adequately for the time I spend with patients, I have 2 basic choices. First, I drop the contracts that pay poorly. Those patients either see another physician who is on their plan or they pay me directly. My second choice is to leave clinical medicine and get a job with a medically-oriented business. I have spoken to many physicians who have chosen one or the other, and they have been helpful understanding the risks, benefits and compromises of each. It is a choice that I will ponder leisurely until I am compelled to make a change.
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