Articles by JCS

Spittin’ Up Their Milk

Spittin’ Up Their Milk

by

JC Smith, MA, DC

 

Managed care, aka, mangled care, seems to have irritated most everyone except for the insurance companies. Most recently, an article in the August edition of Physicians’ Managed Care Report carried an interesting article about MDs dislike of the health care system.

            In a survey by Strategic Health Perspective, 83% of respondents reported that they detest the health care system, compared to 51% in 1984 and 67% in 1997. Their poll also found that 72% of physicians said fundamental changes are needed in the health care system and 11% said the system needs a complete overhaul. Only 10% of physicians said they believe managed care has been successful in improving the quality of care, compared with 43% of the public and 86% of health plan respondents.

            Apparently it’s not only the chiropractors who are getting the shaft from MCOs, but now the long arm of mangled care is tightening its grip around many medical practices too. Now to hear doctors complaining about mangled care comes as no surprise considering that for years these guys milked the golden goose of insurance for everything they could. The carte blanche mentality allowed them to do any procedures to anyone at high prices, no questions asked.

            Now to have MCOs contain this carte blanche attitude must stick in the craw of many MDs. How dare the insurance bureaucrats tell them how to practice medicine! Forget about some estimates that tell us that 78 to 90% of all surgeries are deemed unnecessary. Forget the statement from the AHCPR guideline on acute low back pain that “Surgery has been found to be helpful in only one in 100 cases of low back problems.” Forget the fact at there are 2.2 million adverse drug reactions or that over 100,000 people die from drug reactions each year. These MDs conveniently have forgotten that their excesses were the very cause of the health care reform itself.

            Unfortunately, the pendulum has swung to the other side now. Instead of MDs exploiting the situation for all they can, now we see the excesses being enjoyed by the fat cat CEOs of the MCOs and hospitals. For example, when Aetna bought out the largest HMO, the CEO was given a buy-out of 960 million plus a Lear jet. When the former CEO of Columbia/HCA was convicted of Medicare insurance fraud, he was given as severance pay $10 million cash and 26 million in stock options. His fine was only $500,000 which was chump change to him undoubtedly, and despite the fact that Columbia/HCA was fined $750,000,000 by the government, their stock actually rose the day it was announced! Apparently there’s more money in hospital care than we realize.

In other words, there’s still plenty of money in the healthcare industry, it’s just not going to the providers like it once did. Despite the efforts of MCOs to curtail costs to providers, recently research has shown that overall costs are as high now as they were before mangled care began.

While physicians are working harder for less, patients are being charged more in premiums for less coverage. Now we learn where unethical IMEs are short-changing patients out of what’s due them. The recent Dateline article about Snake Farm’s claim-cutting revealed this sordid practice of cheating patients out of their coverage by using IME firms that have no MDs on staff. Moreover, in 1996, the Court of Appeals in Indiana revealed that Snake Farm was paying out 46 cents on the dollar for claims. And last year when Snake Farm was fined a billion dollars in a class-action suit for substituting off-brand parts in car repairs, they still laughed from the courtroom because reportedly they had saved 3 billion in this scam, so they were still ahead by 2 billion!

 

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