Ethical Health Partnerships

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Reimbursement, Physician Fees - What it all Means for Patients and Ethical Partnership

Reimbursement is what your insurance company pays your physician for services provided. What happens to your physician affects not only him or her, but you and me as patients. It affects the services they offer, our access to quality physicians, the time they spend with us, their stress and satisfaction levels which impacts quality of care and patient safety, and more. It is essential that we understand and take action for them and for ourselves.

With all articles as yourself whether or not current or proposed actions reflect a commitment to ethical health partnerships. How might you help co-create more ethical relationship?

A Picture is Worth 1000 Words -- Insurance Companies & Physician Reimbursement
Charts compare cost of living and rate of reimbursement for common surgical procedures, plus a few examples of malpractice company increases
Does Your Physician Get Paid Too Much?

Discusses doctor's income, practice expenses, reimbursement rates, insurance, what it means for patients and physicians.
Financial compensation and Ethical Issues in Healthcare by Mary Cipriano Silva, PhD, RN, FAAN

Discusses market-driven healthcare, third party payers, efficiency as primary determination of compensation and the ethical issues that creates. Presenting an overview of ethical theory, Silva points out various impacts of the current means of reimbursement and the quality and ethical issues they raise.
(Full text article is at journal site)

Our Submission to the House Ways & Means Committee Hearing on the Proposed Cuts in Medicare Reimbursement

Discusses impact of proposed Medicare cuts on ALL adult patients regardless of age or insurance coverage, impact on physicians, flaws of the SGR formula for payment, and drivers of health costs.
Our Submission to the House Ways & Means Committee Hearing on the Pay-for-Performance Proposal

Discusses pros and cons of pay-for-performance, elements of fairness and more, who will make decisions about treatment and more. (See more articles on pay-for-performance from other sources.)
Proposed Medicare Cuts in Physician Payment: A Problem for all Patients

Discusses why scheduled cuts need to be prevented. This will affect ALL patients and physicians. Insurance companies base their rates on Medicare. This will affect our access to care and quality of care.
Respect Doctors? by Anjuli Sharma

Anjuli Sharma, daughter of a physician, gives a personal perspective of physician's commitment and lifestyle.
Physicians Hands Are Tied in Negotiatiating for Patients or for Themselves
Under current antitrust laws, physicians cannot really negotiate with health insurance companies. Negotiation is not only about physician pay, but about contract issues that affect whether or not patients receive treatment, who makes final care decisions and more. Current laws make it one physician or one group against the insurance company and industry. (Insurance companies are currently exempt from antitrust laws.) Continuing mergers of major companies create a market force which allows insurance to ignore physicians' concerns. In fact, some brag about the fact that they do. In 2004 surgeons were paid by private insurance lower rates than Medicare paid in 1995 for some procedures.
Courts Rule Against Healthcare Insurance Companies for Reimbursement Methods

This article reports about recent settlements of several large insurance companies after being charged with unethical actions in delaying and denying payment of physicians. The allegations and terms of settlement are summarized and provide directions to create more ethical health partnerships.
See Action Center for ways to make your voice heard.
Suggestions for letters or calls to insurance companies, contact information for insurance company executives, state insurance commissioners and more.

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.
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© Dawn Lipthrott, Ethical Health Partnerships, 2004

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

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