{"id":4669,"date":"2012-05-06T22:08:38","date_gmt":"2012-05-07T03:08:38","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=4669"},"modified":"2021-09-05T23:09:45","modified_gmt":"2021-09-06T04:09:45","slug":"behavior-modification-for-doctors-how-insurance-companies-do-it","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/06\/behavior-modification-for-doctors-how-insurance-companies-do-it","title":{"rendered":"Behavior Modification for Doctors: How Insurance Companies Do It"},"content":{"rendered":"\n

Posted 05\/06\/2012<\/p>\n\n\n\n

You don\u2019t see those billboards anymore, the ones advertising health insurance companies (HICs) with some form of this message: We don\u2019t tell your physician how to practice medicine\u2014we let your doctor take care<\/em> of you.<\/p>\n\n\n\n

I guess it was too cynical even for the HICs, an industry in much disfavor these days. Even they had to draw some sort of line about truth in advertising. Tell us how to practice? We doctors are micromanaged by them.<\/p>\n\n\n\n

As you must know, every possible aspect of your health care has been entered into the information system of your own HIC and then shared with other HICs. With this data, HICs can track doctors\u2019 billing patterns, lab tests ordered, prescriptions written, referrals made, and surgical procedures performed. And because every day there are virtually millions of physician-patient encounters, you may be curious to know how a HIC uses behavior modification to keep doctors in line with \u201cacceptable standards.\u201d<\/p>\n\n\n\n

Those quotation marks are deliberate.<\/p>\n\n\n\n

Unsurprisingly, so-called acceptable standards are geared to maximizing HIC profits, having absolutely nothing to do with physician performance or with you getting the best health care. Acceptable standards generally means short and efficient visits, few lab tests, cheapest generic drugs, and as few patients as possible admitted to the hospital. Your HIC also tracks those dreaded pre-existing conditions, and by blocking your access to future health insurance also maximizes its bottom line. But you knew that already.<\/p>\n\n\n\n

Physician \u201coutliers\u201d<\/strong><\/h3>\n\n\n\n

The key tactic HICs use for behavior modification of physician outliers (a HIC industry term describing doctors who don\u2019t play by their rules) is to place hurdles in front of physicians that waste time on irrelevancies. Time is, for all of us, a precious commodity. HICs know this all too well and lay it out like this: Doc\u2014if you don\u2019t want to waste your time on the phone getting prior authorizations for brand-name drugs, writing letters to justify a lab test, or having to copy and fax your medical records for our review, just play it our way. We could make it simple and send Rocky over to break your kneecaps, but really that\u2019s not necessary. Just follow our rules, we\u2019ll leave your kneecaps alone, and you can spend more time with the wife and kids.<\/p>\n\n\n\n

Having related this, let me tell you how I\u2019ve been spending my mornings.<\/p>\n\n\n\n

Each day I arrive in the office about 30 minutes early to write a letter to a HIC in response to a letter I received from them the day before. Most letters begin \u201cWe welcome the opportunity to be of service to you,\u201d a phrase frightening enough to tighten anyone\u2019s stomach. It seems the HIC wants \u201cadditional information,\u201d a \u201cnarrative report,\u201d \u201cpatient progress notes,\u201d and so forth.<\/p>\n\n\n\n

They want my reasons for ordering a specific test that, in this series of letter requests, measures food allergies. Testing patients for sensitivities to foods they\u2019re eating is \u201cout of the box\u201d thinking to them, making me a dreaded outlier and their computers smoke.<\/p>\n\n\n\n

Why would I–or any competent physician–want to know what foods his patients are allergic to?<\/p>\n\n\n\n

If you\u2019ve been following the health tips and remember the two-part article Toxic Food Syndrome<\/a>, you could probably write this letter yourself. Perhaps in my own letter I\u2019ll  relate the story of:<\/p>\n\n\n\n