Staying Independent...Together

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   RE: vaccine billing- maybe everyone else already knows..
 From: Jean Antonucci
 To: Member Forum
 Posted: 08-13-2017 11:20
Peter- Insurance is a business plus rules and regulations are enacted
It  is miserbale but isn't personal  we need  to  get over it
Everyone  reads this stuff and starts to rant Preaching to the choir    I know you are trying to do something  but as a rule PCps are so quiet and politically inactive we are  part of the problem  Could you tell us about your practice or current work Peter?


     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544


------Original Message------

Does anyone else think the Byzantine rules for getting reimbursed for vaccines, MCR well visits, etc., are just more evidence of insurers (most definitely including Medicare!) abusing us?

(From a screed I wrote a few years ago:)

Medicare and other insurers ('They') have the following relationship with physicians ('Us'):

  • They have much greater economic power
  • They use their economic power to control us
  • They create the rules for the relationship
  • We can't know all the rules (130,000 pages)
  • If we misinterpret or break the rules, they punish us by withholding payment
  • If they misinterpret or break the rules, they punish us by withholding payment
  • If they break the rules we have no recourse
  • We can't change the rules
  • They can change the rules without our consent
  • They can change the rules without our knowledge
  • They imply that not going along with their rules means we don't care about patients (quality)
  • We can't leave because they control the money, and people (patients) who depend on us would be hurt
  • They tell us we can't do anything right (frequent and routine denials of claims)
  • Their payment system (FFS) encourages overuse- exactly the behavior Medicare says they want to discourage
  • They hurt us (impose EMRs and other excessive bureaucratic tasks) then tell us it's our fault we can't comply with them
  • We learn we need to distort our behavior to survive.
  • We're burned out. That's not their problem. All we have to do is follow the rules (all 130,000 pages of them.)
  • What they pay for controls what we can do for the patient
  • They won't pay us for the services the patient needs
  • They don't trust us to do what's right for the patient
  • They don't trust us to provide the services the patient needs
  • They blame us for not providing the services the patient needs
  • They blame us when something goes wrong
  • They don't take our complaints seriously
  • They can decide after the fact that what we did was unnecessary (and thus deny payment,) when necessity couldn't be determined in advance
  • They threaten us with witch hunts (RAC attacks) where they can decide ex-post-facto that we didn't describe something well enough, and take back payment for it
  • We're guilty until proven innocent- at our expense
  • They minimize the difficulties we have conforming to their rules
  • They blame us for the problems in the system
  • They say they care about patient welfare and reducing costs, but they devalue primary care, which delivers better care at lower cost
  • Their policies have caused the shortage of primary care, but they take no responsibility for it
  • They keep saying things will get better, but they keep getting worse (more bureaucracy, decrease in primary care reimbursement after inflation, more data collection, more threats)

Now, that may not be what administrators at CMS intended, but that's what insurance companies (and Medicare) do.

What I've just described, of course, is an abusive relationship.  Many physicians understand intuitively they're abused by insurance companies & Medicare, but haven't recognized it explicitly.  Don't take my word for it.  Ask a dozen family therapists or psychiatrists whether this is an abusive relationship.  Most realize this, which is why few of them accept insurance.

Healthy relationships involve mutual respect, trust, honesty, support, fairness/equality, good communication and consideration for the other party.  Unfortunately that doesn't describe the relationship between insurances or CMS and primary care.  Abusers notoriously change their behavior after beating up their partners, buying flowers and making nice. They promise they'll never do it again. Insurers constantly trot out new programs to improve patient care and reduce cost without reducing quality. "Trust us. This time will be different."  After enough repetitions, the abused party no longer believes the abuser.

Abusers want all of the power and control in the relationship and work to maintain that situation, continuing unhealthy and harmful behavior patterns. "Couples counseling" requires both partners to take responsibility for their actions and make adjustments to their behavior.  But "couples counseling" implies both partners contribute to the abusive behavior, but the choice to create an abusive relationship lies solely with the abuser. Only if the abuser acknowledges that they have a problem with abuse and are prepared to openly deal with it can abuse therapy even have a chance to be successful. Most abusers are not prepared to admit their behavior.


Insurance companies and CMS say, "Who, me?  Just follow our rules and you'll be fine."

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA

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