Medical Tuesday Blog

HMOs Practicing Parallel Medicine And Interfering With Patient Care

May 22

Written by: Del Meyer
05/22/2017 3:25 AM 

Health Maintenance Organizations are becoming more aggressive in taking over the health care of the insured. They have unobtrusively sent physicians, who are not the patient’s personal physician, to visit our patients, interview them, examine them, do very detailed personal/social interviews, make various and sundry recommendations about their habits, medications, their diets, drinking, and other behavior.

Our patients are complaining about this intrusion into their lives at home and some have said the “traveling doctor” stated their purpose was to do the annual physical examination recommended by Medicare but not done by their personal physician (Their PCP). Some have shown the “HMO” doctor to the door. Others have been able to intercept and avoid this intrusion on the phone when the HMO calls to make the “Medicare approved” call. One felt this must be a very high level government Medicare supervising physician to check for incompetence. After understanding the interview, as recalled by the patient, it appears that some of the recommendations were inappropriate and actually reduced the level and quality of care. The patient then realized that the incompetency lay with the HMO government Medicare doctor and then wanted to take legal action against Medicare. We were successful in squelching this.

Since HMOs are squeezing doctor reimbursement, this extra HMO money for professional services rightly belongs to the treating physician. What is the real message the is being rendered? HMO’s receive the patient care money and feel free to divvy it up as they see fit? Why is the personal physician being overrun? Splitting the professional portion of the reimbursement from the insurance coverage to a non-treating HMO physician is totally unethical. The HMO is no longer supporting its own physician members. It looks like another reason to get out of HMOs. But where is our exit?

If this is indeed Medicare authorized or induced, Medicare is no longer on the physician side of the health care equation. Then the combination of Medicare advantage which teams Medicare with HMOs with regulatory power, is no longer physician friendly, and physicians should no longer participate. But where is our Exit?

But this whole problem and misunderstanding is primarily on the Regulatory side, whether, Medicare, Medicaid, private insurance, HMO, Congress, the White House, or entities yet unknown.

Healthcare was personal, affordable from antiquity until the 1950s when the government illiterates became involved. Physicians, being a trustworthy and patient oriented group hardly noticed. As our professional organization became more political involved, physicians couldn’t comprehend that our friends were no longer our friends, much less working against us. Many physicians never comprehended that when our representatives stated a big advantage was their advocating for us. Many of us never realized that they were not advocating for the private practice of medicine, but for government medicine, for single payer medicine, for socialized medicine, and more recently for Obamacare.

HMOs, having a second doctor on every patient who makes house calls and a complete medical evaluation, must double the cost of healthcare. House calls, in and of themselves, are more time consuming than office calls, generally two to three times as long, particularly if the second patient is more than 20 minutes away from the first patient. The HMO executives need to attend a conference of the Lean Medicine Institute since they seem to be going in the opposite and more costly direction, not to mention their distrust of their own panel of physicians.

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