Thursday, May 29, 2008

Tiered Doc Copays

Here is a novel idea.

Create a system where price AND quality is evaluated. Those who perform at a higher level are paid more, while those who perform at a lower level are penalized.

Then take it a step further.

Inform the provider's clientèle who measures up and who doesn't.

If your clients want to use a practitioner who does not make the grade, they must be willing to pay more out of pocket to use that provider.

This is precisely what the Massachusetts Group Insurance Commission has done.

And is seems the docs are not happy.

In a lawsuit filed in Suffolk Superior Court, the (Massachusetts Medical Society) - which represents the state's doctors - alleges the commission's plan hurts physicians and patients.

The suit claims doctors capriciously ranked lower have been defamed, and that patients who have to pay higher copayments based on their doctor's ranking have been defrauded.

The patients are defrauded.

That's a gutsy claim.

Tiering has become a widespread technique for controlling healthcare costs. For example, many insurers have adopted tiered pharmacy benefits, with higher copayments for name-brand drugs serving as an inducement for patients to choose generics. Such structuring is credited with controlling spiraling drug costs.

But the tiering of physicians has proceeded more slowly. Doctors have fought the cost-control methods, particularly tiering plans that seek to rank individual doctors, as opposed to physician practices.

So, carriers and patients should pay the same price, regardless of the ability of the medical practitioner to treat medical conditions?

In other words, you should pay just as much for top level care as you would for a lower level of care.

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