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Catalyzing Events - What Led to this Website

women surgeons

Summary:
I discovered that my insurance paid my surgeon less than 25% of her billed fee, and that my insurance is one of the better paying ones. I also discovered that:
* private insurance bases payment to physicians on Medicare rates, and some pay less
* that surgeons are paid less today than Medicare paid for the same operation in 1995 in spite of increasing expense
* that in Florida surgeons and ob-gyns pay between $150,000 and up to $277,000 for malpractice insurance even when they have never had a claim
* that doctors are forced to increase numbers of patients to keep pace, leading to increasing dissatisfaction for both doctors and patients and sometimes reduced quality
* that while doctors are being paid less, patients are paying more and more for insurance, while insurance companies are making record profits.
That is an injustice to physicians and to patients.

Event #1 -- Personal Experience:
After living my whole life with very little direct contact with the healthcare system, in 2004 I had surgery twice. Both were common surgeries . . . a breast biopsy and gallbladder surgery. Both were very positive experiences on many levels.

A big part of my positive experience was the exceptional care I received from my surgeon. She was very knowledgeable, thorough, straightforward but sensitive, caring and warm in a very professional way, and clearly she held herself and the people around her to a high standard of excellence. Because I had done my homework, I know she gave me not just good care, but exceptional care from beginning to end. It was what many of us dream of for our healthcare.

The primary catalyst for this website was what happened to my surgeon after my surgery.

I glanced at the notice that my insurance had paid the surgeon, to make sure I didn't owe anything. Before I put it in the drawer, I was curious about just how much the surgery cost. To my surprise, I saw that my insurance paid the surgeon less than 25% of her billed amount. Since I had paid my deductible, she could not bill me. I checked back on other charges, surprised at the huge gap. Her other charges were paid more fairly and none of her fees were outrageously high. Why was this one so different? I contacted the state medical association and the American College of Surgeons to try to find out an average fee nationally or statewide and discovered that they cannot keep statistics on fees because it is in violation of antitrust laws. Physicians cannot even discuss fees with another physician.

I found an old copy of a book, Medical Fees in the United States, which showed the median feesfor for surgeries and other medical procedures. The median fee represents the fee at which half of surgeons in the United States charged more, half charged less. What was paid to my surgeon was about 1/3 of that old median fee in the year 2000. I later discovered that low paying Medicare paid more to surgeons in 1995 than my surgeon was receiving now in 2004 from my insurance company.

To me, that is an injustice to my physician (and all others) and ultimately to me, the patient. As I continued to investigate, I discovered how reimbursement rates have steadily decreased for some of the most common procedures, while doctors' costs have steadily increased with inflation, staff salaries and cost of supplies. And for many, especially surgeons and other high-risk specialties, malpractice insurance rates increase in double digit percentages every year -- sometimes 30-45%. I began to wonder how physicians in solo practice, no matter how good they are, can stay in practice.I know of more than one physician in my city who has closed his or her practice because they can't afford to keep it open, but I never knew why.

Moreover, in the 4 years preceding my surgery, my health insurance premiums had doubled, even though I never used it except for routine annual exams. While my insurance is doubling, my surgeon is paid less than Medicare paid in 1995. There is something wrong with that picture. An injustice is being committed, essentially in my name as a patient, and as an insured with that company (others insurance companies pay the same or even lower.)

Where is the money going?

I read in the South Florida Business Journal (September 22, 2004),

"According to the Weiss ratings, profits for the nation's life and health insurers jumped $5.9 billion to $8.7 billion in the first three months of 2004. Weiss reported that "life and health insurance industry profitability for the first quarter reached its highest level in 10 years. Weiss Ratings attributed the rise primarily to a $3.1 billion improvement in capital gains and a $1.5 billion increase in investment income."

I further read about the malpractice insurance industry, about the enormous increases in premiums for physicians (averaging 46% per year in Florida), insurance investments, underwriting practices, insurance profits, tort reform (reform of the malpractice lawsuit process), and effects of all this on physicians and patients.

It all made me wonder how long my surgeon, who is such an excellent physician, can continue . . . not just financially, but also in terms of the stress and emotional drain of fighting it all while trying to give good care. Imagine what it might be like working in that climate every day. Those increasing costs and decreasing income leads most physicians to try to squeeze in more patients. Often that reduces quality, increases dissatisfaction for both patient and physician, and can potentially lead to increased errors. That hurts all of us. An injustice to anyone, physician or patient or other partners in our system, impacts everyone.

Event 2: The Election in Florida:
With malpractice related amendments on our ballot, I saw how adversarial the system has become and how that is shaping my healthcare and the relationship with my physician. It also brought home very clearly how everyone points the finger at someone else instead of taking the bull by the horns and addressing their own parts of contributing to the problems. In fact, when physicians here filed a bill to place caps on awards for the pain and suffering portion of a malpractice award, attorneys countered by filing a bill against physicians and leaders of the trial lawyers group acknowledged that it was simply in retaliation for the physicians' bill. That's called a power struggle. And to simply get back at one another is not in the interest of the patient.

I haven't even started to learn about pharmaceutical companies and other corporate and political interests that also shape our healthcare and costs.

So what?
If I were to simply say, "Oh well, too bad . . .that's how it is these days", I would be passively supporting the injustice and I am not willing to do that. Even if I am not sure how to best address it, to do nothing is to go along with it. So this website is one step I can take.

ALL of us are responsible--both for the problems and for the solutions. And part of what I know is that issues are also about a deeper problem, one that has to do with the relational context that all of us are part of. How do we create more ethical partnerships? How do we use the truth that all parties have, to provide quality care, without destroying the very ones who are taking care of us or patients themselves? How do we empower ourselves as patients, both for our own health and our healthcare? How do we act more honorably in our dealings with one another?

A foundational part of the solution involves re-creating ethical partnerships, calling ourselves and others to live and work from the very best of who we are as human beings, and re-claiming our power as we each address our personal responsibility.

© Dawn Lipthrott, Ethical Health Partnerships, 2004, revised 2007     www.ethicalhealthpartnerships.org
(May be copied and distributed as long as this identifying information is retained on copies.)

As always, I welcome your constructive comments and suggestions about the material on this website and how we can all be most effective in co-creating the kind of healthcare system we all want.
E-mail me at ideas@ethicalhealthpartnerships.org
© Dawn Lipthrott, Ethical Health Partnerships, 2004 www.ethicalhealthpartnerships.org

(May be copied and distributed as long as this identifying information is retained on copies.)

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