Time to Cut Physician Reimbursement Red Tape

This week’s headlines trumpeted, "Computer glitches, overloads hit health care exchanges." Meanwhile, other headlines note that little else is working in the federal government because of a government shutdown. This is not the first time in history the federal government has shut down; it used to happen regularly during the Reagan administration.

The shutdown does tend to obscure what I think is the more interesting addition to the healthcare landscape: there is now such a thing as "Healthcare.gov."  On Tuesday, Oct. 1, 2013, for the first time in history, the federal government became involved in providing healthcare insurance for average, working-age Americans.

If you want to know more about the program, just take a look at the government’s YouTube page and you will see why people at HHS are so happy. Actors in upbeat videos portray good, hard-working Americans who love the peace of mind which comes with receiving things they can’t possibly afford.

Technically, just like the actors pictured in these videos, Americans are supposed to purchase insurance through the newly-created exchanges, and then receive an income-adjusted refund at tax time. But the government, having actually met the people portrayed in the videos, has decided no real person would ever buy insurance unless the tax credits were applied each month, in order to lower each month’s premium payment. I think that means that the happy people depicted in the videos will pay a small amount, and the government will be paying an insurance company for the remaining cost of the policy. 

As a new era dawns with the creation of healthcare insurance exchanges, this would also be a very good time to take a serious look at putting more money into the pockets of hard-working physicians by addressing the horrid state of claims processing in this country.

The AMA reports the average solo physician practice spent $70,000 in 2006 simply trying to get paid. An in-house attorney doesn’t cost $70,000 in many areas. Why does each physician spend this much fighting to get paid? The answer lies with the original masters of "gamesmanship" in the claims denial process: HHS.

Somewhere between the creation of Social Security in 1935 and the mid-1980s, the government figured out it pays to "just say no" to Social Security disability claimants. When even legitimate claims were denied, many people would simply give up and go away. This is a technique most every physician knows all too well.

As we begin to correct the bugs in the health insurance exchanges, it is time to also give some thought to reducing the $70,000 paid by each solo physician in the fight to get paid.