Health system cripples independent physicians

The News-Leader has done a good job in the past month in focusing on the present health care crisis. Several doctors and other interested parties have written cogent arguments for health-insurance reform. Your editorials have made clear that health care is too expensive and there are "too many layers between the patient and doctor, and too many more layers between the doctor and the ultimate payer". It is these excess layers, of course, that contribute to making modern medical care so expensive, and undermine the doctor - patient relationship.

The present "system" allows for three models of healthcare coverage:

1. Entitlement, paid mostly by the government (Medicare and Medicaid);

2. Private insurance, most of which has become some form of PPO with a restricted panel of providers - or the even more restrictive HMO model;

3. Fee-for-service, in which the patient pays "out of pocket" for "non-covered" services - or patients without insurance pay for all their care.

Models 1 and 2 used to allow patients to choose any willing physician provider for their care. With the advent of the Medicare drug bill and intensive advertising by insurance companies, some hospital-sponsored, many Medicare patients have accepted all the provider restrictions of present-day model 2, "Medicare managed care," in hopes of decreasing their co-insurance responsibility. Most of these insurance products dictate which health care system and which panel of physicians the patient may see.

Practically speaking, Springfield has an HMO model in St. John's system, a PPO model in Cox's system, and a few, dwindling number of independent physicians. In the old days, a patient could choose to see a doctor in any or all 3 of these systems. For many of our citizens, thanks to the insurance changes noted above, this is no longer true.

Because I had practiced very successfully in Springfield for 15 years and we loved the city and area, Dr. Priscilla Arnold and I decided to open our new facility here in 2004. In the three years since opening our new eye practice in Springfield, Arnold Vision, we have been astounded at the difference in the medical environment compared to just 8 years ago. The restrictions placed on patients by their insurance companies are remarkable. Even many patients with the benefits of our present universal health coverage, Medicare, have signed over those rights to managed-care plans that restrict their choice of physicians. As independent physicians, we have been locked out of "the system" in Springfield.

The quality of our care, our credentials and our beautiful new facility would compare favorably to the other highly qualified eye doctors in our community - just ask our patients. Nonetheless, in this restrictive environment, we have not been able to generate a sufficient patient volume to remain economically viable. We are forced to close our practice and find another community in which to share our skills.

Missouri should support an "any willing provider" law. This would allow any qualified physician willing to accept the terms of the insurance contract to participate on the panel of acceptable providers.
source:www.news-leader.com