Doctors say insurance company rankings of doctors are based on cost, not quality. Will a new patient charter resolve the debate?
Comment: I am a doctor, and I am not robbing anybody. One insurance plan pays me $13 to see a sick child. At that rate, how many sick children do I need to see per day to pay off my $200,000 in medical school loans? We need to recognize that insurance companies are the robber barons profiteering on our suffering.
Comment: I'm a doctor, and I don't think I'm robbing anybody. One insurance plan pays me $13 to see a sick child in my office. The American people need to recognize that insurance companies are the robber barons profiteering on all of our suffering.
Comment: In Canada, you may wait over a year for a surgery! People need to quit thinking Canada is better because it is cheaper and 'free' for its citizens.
We need quit blaming our doctors and look more closely at the insurance companies and their practices in this country. Instead of politicians trying to go for a 'universal' healthcare system, they need to try and reform the broken system we have.
Comment: In Canada, an American goes to the doctor and pays cash for that visit in Canada; that cash price in Canada is less than or equal to the Americans deductible for a visit to the same quality doctor in the USA. We are being robbed by the insurance companies, doctors, politicians and news people.
Intelligence analyst: Getzel
Comment: Insurance companies do not do ANYTHING objectively. They pretend to, and they obviously do a good job of fooling people.
Comment: In Canada, an American goes to the doctor and pays cash for that visit in Canada; that cash price in Canada is less than or equal to the Americans deductible for a visit to the same quality doctor in the USA. We are being robbed by the insurance companies, doctors, politicians and news people.
Intelligence analyst: Getzel
Comment: Dear doctor! Wake up. The insurance industry is not your friend. It is an industry! The "all mighty" buck rules!
You as a physician must stay true to yourself and be the advocate of our patients. You are it.
I have not seen our government or our political organizations care either.
Certainly we want to be efficient and practice high quality care but that is not the motivator of the insurance /government. There only quality measure is "the cheaper the better" and best is "not to provide the care at all".
When are we waking up and promote "wellness" and "disease prevention" instead of spending most of the healthcare dollars for treating diseases (most of these are preventable)?
When are we paying primary care physicians appropriately and help them with there task instead of wasting the money on high level procedures and tests?
Until then do the best for your patients and do not compromise!
Comment: Dear doctor! Wake up. The insurance industry is not your friend. It is an industry! The "all mighty" buck rules!
You as a physician must stay true to yourself and be the advocate of our patients. You are it. I have not seen our government or our political organizations care either.
Certainly we want to be efficient and practice high quality care but that is not the motivator of the insurance /government. There only quality measure is "the cheaper the better" and best is "not to provide the care at all".
When are we waking up and promote "wellness" and "disease prevention" instead spending most of the healthcare dollars for treating diseases (most of these are preventable). When are we paying primary care physicians appropriately and help them with there task instead of wasting the money on high level procedures and tests.
Comment: Wake up it is all about the "all-mighty buck".
The only defense patients have is finding a doctor like you who cares about patients. You certainly want to look into ways to be more efficient but also need to make sure to not compromise patient care. The insurance industry really doesn't give a "flip" about education of patients/ preventive care, and they are not interessted in true "wellness". Why are we spending 80-90% on disease management that can be prevented and only very little on preventive care?
They don't care and want you to cut your patients short. Don't do it. Stay true to yourself and what you owe your patients. We are our patients advocates!
Comment: I'm a doctor and Blue Cross compares me to other MDs. Surprisingly, my rankings are low, despite the fact that I was nominated as the best doctor in my community based on public voting in a major newspaper. When I looked closer, I found my low rank was because 47% of the prescriptions I write were for drugs that were not generic or "preferred brand" in the formulary.
How the formulary works: a generic drug is supposed to be the MD's 1st choice, no matter what. If there's no generic, use the preferred brand. Prozac is a generic antidepressant, so I'm supposed to give it to every depressed patient, whether or not it's the best choice for that patient. Before Prozac went generic, the preferred brand was Zoloft, and I was supposed to give every depressed patient Zoloft, even if it wasn't right for them. Neither Prozac or Zoloft is a better. What matters is that the patient's Rx takes into account things like side effects, other drugs taken, their lifestyle, other meds they've tried, and even things like personal prejudices ("My uncle took that and it made him sick!"). Only if you look at the whole person will you find a Rx that is right for them, one they'll actually take.
Studies show 1/3 of prescriptions are never filled, and 1/2 of those filled are taken as directed. This means only 1/3 of all Rx meds are used correctly. Why? Because patients don't believe a pill will help unless it's chosen for THEM, and the choice explained by their doctor. My personal statistic of prescriptions taken as directed is 73%. I take time to talk to my patients and include them in decision making. Many of my patients actually get better and cost the insurance company less, but this isn't pertinent to Blue Cross; it's not a statistic they track.
In the end, all I care about is whether or not my patients get well. I don't care about the Blue Cross formulary because it's arbitrary. They don't chose the best drug in each class, sometimes they don't chose the cheapest. The formulary is decided in back room deals between the pharmaceutical and insurance executives, who care about profits, not people.
Another MD proudly showed me his Blue Cross letter giving him the highest rating. This fellow has been sued for malpractice several times. (Thankfully, I've never been sued, not even named in another doctor's suit). My opinion of this other doctor is that he is the most dangerously under-educated MDs in our community. But he ranks high with Blue Cross. He follows their Rx cook book and rushes through patient visits, making him look "efficient." But how efficient is it if the patient leaves with a illegible piece of paper not even knowing the name of the drug or how it helps them? Only 33% of patients are willing to take their chances on such a crap shoot, whereas 73% of my patients take their meds as directed.
It's pretty obvious to Blue Cross that I'm a terrible doctor.
Comment: I'm a doctor and Blue Cross compares me to other MDs. Surprisingly, my rankings are low, despite the fact that I was nominated as the best doctor in my community based on public voting in a major newspaper. When I looked closer, I found my low rank was because 47% of the prescriptions I write were for drugs that were not generic or "preferred brand" in the formulary.
How the formulary works: a generic drug is supposed to be the MD's 1st choice, no matter what. If there's no generic, use the preferred brand. Prozac is a generic antidepressant, so I'm supposed to give it to every depressed patient, whether or not it's the best choice for that patient. Before Prozac went generic, the preferred brand was Zoloft, and I was supposed to give every depressed patient Zoloft, even if it wasn't right for them. Neither Prozac or Zoloft is a better. What matters is that the patient's Rx takes into account things like side effects, other drugs taken, their lifestyle, other meds they've tried, and even things like personal prejudices ("My uncle took that and it made him sick!"). Only if you look at the whole person will you find a Rx that is right for them, one they'll actually take.
Studies show 1/3 of prescriptions are never filled, and 1/2 of those filled are taken as directed. This means only 1/3 of all Rx meds are used correctly. Why? Because patients don't believe a pill will help unless it's chosen for THEM, and the choice explained by their doctor. My personal statistic of prescriptions taken as directed is 73%. I take time to talk to my patients and include them in decision making. Many of my patients actually get better and cost the insurance company less, but this isn't pertinent to Blue Cross; it's not a statistic they track.
In the end, all I care about is whether or not my patients get well. I don't care about the Blue Cross formulary because it's arbitrary. They don't chose the best drug in each class, sometimes they don't chose the cheapest. The formulary is decided in back room deals between the pharmaceutical and insurance executives, who care about profits, not people.
Another MD proudly showed me his Blue Cross letter giving him the highest rating. This fellow has been sued for malpractice several times. (Thankfully, I've never been sued, not even named in another doctor's suit). My opinion of this other doctor is that he is the most dangerously under-educated MDs in our community. But he ranks high with Blue Cross. He follows their Rx cook book and rushes through patient visits, making him look "efficient." But how efficient is it if the patient leaves with a illegible piece of paper not even knowing the name of the drug or how it helps them? Only 33% of patients are willing to take their chances on such a crap shoot, whereas 73% of my patients take their meds as directed.
It's pretty obvious to Blue Cross that I'm a terrible doctor.
Comment: Under the old fee-for-service way of doing things, we established that doctors were lousy businessmen. Under managed care, we have established that businessmen are lousy doctors.
Personally, I find all of my doctors the old-fashioned way - I ask other nurses.
Nurses know which doctors have low infection rates, low complication rates, and what kind of bedside manner a doctor has. We know who drinks, and who doesn't. We know who keeps up on the latest information, who is woefully out of date, and perhaps most important of all, who does the best job of listening to their patients.
Want to find the best doctor? Ask a nurse. Better yet, go to the doctors the nurses go to, and the ones they trust their family members to.
C.MacLean, RN, MS
Comment: Dear Nurse MacLean, I thoroughly agree with you about the best way to chose a doctor. And I would like to say that I think nurses hold up the world. God bless you all.
Comment: so true
Comment: Under the old fee-for-service way of doing things, we established that doctors were lousy businessmen. Under managed care, we have established that businessmen are lousy doctors.
Personally, I find all of my doctors the old-fashioned way - I ask other nurses.
Nurses know which doctors have low infection rates, low complication rates, and what kind of bedside manner a doctor has. We know who drinks, and who doesn't. We know who keeps up on the latest information, who is woefully out of date, and perhaps most important of all, who does the best job of listening to their patients.
Want to find the best doctor? Ask a nurse. Better yet, go to the doctors the nurses go to, and the ones they trust their family members to.
C.MacLean, RN, MS
Comment: Under the old fee-for-service way of doing things, we established that doctors were lousy businessmen. Under managed care, we have established that businessmen are lousy doctors.
Personally, I find all of my doctors the old-fashioned way - I ask other nurses.
Nurses know which doctors have low infection rates, low complication rates, and what kind of bedside manner a doctor has. We know who drinks, and who doesn't. We know who keeps up on the latest information, who is woefully out of date, and perhaps most important of all, who does the best job of listening to their patients.
Want to find the best doctor? Ask a nurse. Better yet, go to the doctors the nurses go to, and the ones they trust their family members to.
C.MacLean, RN, MS
Comment: Under the old fee-for-service way of doing things, we established that doctors were lousy businessmen. Under managed care, we have established that businessmen are lousy doctors.
Personally, I find all of my doctors the old-fashioned way - I ask other nurses.
Nurses know which doctors have low infection rates, low complication rates, and what kind of bedside manner a doctor has. We know who drinks, and who doesn't. We know who keeps up on the latest information, who is woefully out of date, and perhaps most important of all, who does the best job of listening to their patients.
Want to find the best doctor? Ask a nurse. Better yet, go to the doctors the nurses go to, and the ones they trust their family members to.
C.MacLean, RN, MS
Comment: Even punctuality is a function of the patient and not the doctor. If the Doc's 8 o'clock was late and his 10 o'clock was late and he/she gets backed up or if he/she has to send someone to the hospital (ie fill out AND dictate transfer orders) then his 1 o'clocker is going to think he is horribly late and unprofessional.
Comment: I would think the reason that Dr. Carstensen did not mention the name of the insurance company is because of the fear of a lawsuit even though he may be 100% correct. This is intimidation. I wonder if the insurance company could be investigated for racketeering.
Comment: I would think the reason that Dr. Carstensen did not mention the name of the insurance company is because of the fear of a lawsuit even though he may be 100% correct. This is intimidation. I wonder if the insurance company could be investigated for racketeering.
Comment: I would think the reason that Dr. Carstensen did not mention the name of the insurance company is because of the fear of a lawsuit even though he may be 100% correct. This is intimidation. I wonder if the insurance company could be investigated for racketeering.
Comment: Dear Rural Doc, I think that almost all health insurance companies in America should be investigated for racketeering. They do intimidate their doctors. They withhold payments also, refusing to pay valid claims, forcing doctors to spend much time and money filing counter claims, appeals and lawsuits just to get paid for services rendered. And the insurance company sets the prices for the doctor's services, but adds no premium for the administrative expenses that the insurance companies force the doctors to incur, administrative burdens that are demanded by the insurance companies and are not pertinent to the doctor's practice or the patient's heath at all. It is a racket.
Comment: I would think that Dr. Carstensen did not name the insurance company because of the possibility of a lawsuit against him even though he may be 100% correct and the insurance company is wrong. This is intimidation.
Comment: I'm a doctor and Blue Cross compares me to other MDs. Surprisingly, my rankings are low, despite the fact that I was nominated as the best doctor in my community based on public voting in a major newspaper. When I looked closer, I found my low rank was because 47% of the prescriptions I write were for drugs that were not generic or "preferred brand" in the formulary.
How the formulary works: a generic drug is supposed to be the MD's 1st choice, no matter what. If there's no generic, use the preferred brand. Prozac is a generic antidepressant, so I'm supposed to give it to every depressed patient, whether or not it's the best choice for that patient. Before Prozac went generic, the preferred brand was Zoloft, and I was supposed to give every depressed patient Zoloft, even if it wasn't right for them. Neither Prozac or Zoloft is a better. What matters is that the patient's Rx takes into account things like side effects, other drugs taken, their lifestyle, other meds they've tried, and even things like personal prejudices ("My uncle took that and it made him sick!"). Only if you look at the whole person will you find a Rx that is right for them, one they'll actually take.
Studies show 1/3 of prescriptions are never filled, and 1/2 of those filled are taken as directed. This means only 1/3 of all Rx meds are used correctly. Why? Because patients don't believe a pill will help unless it's chosen for THEM, and the choice explained by their doctor. My personal statistic of prescriptions taken as directed is 73%. I take time to talk to my patients and include them in decision making. Many of my patients actually get better and cost the insurance company less, but this isn't pertinent to Blue Cross; it's not a statistic they track.
In the end, all I care about is whether or not my patients get well. I don't care about the Blue Cross formulary because it's arbitrary. They don't chose the best drug in each class, sometimes they don't chose the cheapest. The formulary is decided in back room deals between the pharmaceutical and insurance executives, who care about profits, not people.
Another MD proudly showed me his Blue Cross letter giving him the highest rating. This fellow has been sued for malpractice several times. (Thankfully, I've never been sued, not even named in another doctor's suit). My opinion of this other doctor is that he is the most dangerously under-educated MDs in our community. But he ranks high with Blue Cross. He follows their Rx cook book and rushes through patient visits, making him look "efficient." But how efficient is it if the patient leaves with a illegible piece of paper not even knowing the name of the drug or how it helps them? Only 33% of patients are willing to take their chances on such a crap shoot, whereas 73% of my patients take their meds as directed.
It's pretty obvious to Blue Cross that I'm a terrible doctor.
Comment: I'm a doctor and Blue Cross compares me to other MDs. Surprisingly, my rankings are low, despite the fact that I was nominated as the best doctor in my community based on public voting in a major newspaper. When I looked closer, I found my low rank was because 47% of the prescriptions I write were for drugs that were not generic or "preferred brand" in the formulary.
How the formulary works: a generic drug is supposed to be the MD's 1st choice, no matter what. If there's no generic, use the preferred brand. Prozac is a generic antidepressant, so I'm supposed to give it to every depressed patient, whether or not it's the best choice for that patient. Before Prozac went generic, the preferred brand was Zoloft, and I was supposed to give every depressed patient Zoloft, even if it wasn't right for them. Neither Prozac or Zoloft is a better. What matters is that the patient's Rx takes into account things like side effects, other drugs taken, their lifestyle, other meds they've tried, and even things like personal prejudices ("My uncle took that and it made him sick!"). Only if you look at the whole person will you find a Rx that is right for them, one they'll actually take.
Studies show 1/3 of prescriptions are never filled, and 1/2 of those filled are taken as directed. This means only 1/3 of all Rx meds are used correctly. Why? Because patients don't believe a pill will help unless it's chosen for THEM, and the choice explained by their doctor. My personal statistic of prescriptions taken as directed is 73%. I take time to talk to my patients and include them in decision making. Many of my patients actually get better and cost the insurance company less, but this isn't pertinent to Blue Cross; it's not a statistic they track.
In the end, all I care about is whether or not my patients get well. I don't care about the Blue Cross formulary because it's arbitrary. They don't chose the best drug in each class, sometimes they don't chose the cheapest. The formulary is decided in back room deals between the pharmaceutical and insurance executives, who care about profits, not people.
Another MD proudly showed me his Blue Cross letter giving him the highest rating. This fellow has been sued for malpractice several times. (Thankfully, I've never been sued, not even named in another doctor's suit). My opinion of this other doctor is that he is the most dangerously under-educated MDs in our community. But he ranks high with Blue Cross. He follows their Rx cook book and rushes through patient visits, making him look "efficient." But how efficient is it if the patient leaves with a illegible piece of paper not even knowing the name of the drug or how it helps them? Only 33% of patients are willing to take their chances on such a crap shoot, whereas 73% of my patients take their meds as directed.
It's pretty obvious to Blue Cross that I'm a terrible doctor.
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