Patients Caught In The Crossfire Of HMSA’s ‘War On Doctors’

A new payment system for doctors rewards physicians for healthier patients who require less care. That doesn’t bode well for patients who require complicated, expensive care.

April 26, 2016  By Representative Cynthia Thielen (Kailua,Kaneohe Bay)

HMSA is harming patients with its war on doctors. This year, the state’s largest health insurer yanked doctors’ previously earned ability to order medical tests without pre-approval delays. This month, it’s changing doctors’ pay. In essence, the less time and tests that a doctor gives patients, the more money the doctor gets.

HMSA’s new payment system replaces the fee-for-service structure that reimburses doctors based on the types of medical services rendered and the number of visits. The new system even rewards physicians with financial bonuses for healthier patients who require less medical care.

So the squeeze is on for caring, skilled doctors and consequently, HMSA’s 720,000 member-patients. The new compensation system is called capitated payments. Some might call it decapitating patients’ rights or crippling doctors, and HMSA’s comments to the contrary are appalling.

civil beat doc 2

HMSA’s “capitation system” for compensating its physicians and others like it put doctors at financial risk, argues the American College of Physicians.

Capitation pays doctors a fixed rate that apparently falls between the general range of $20 and $80 per patient per month in a practice – whether or not a patient visits the doctor. Money-wise, the best scenario is healthy patients who don’t visit the office because sicker patients who require more time, care and expensive tests may lead to the doctor’s practice spending more money than it receives.

The danger is that the financial reality could be to limit complicated patient cases because it might take just one patient with a serious illness to bankrupt a medical practice.

The American College of Physicians website says, “Capitation payments are used by managed care organizations to control health care costs. Capitation payments control use of health care resources by putting the physician at financial risk for services provided to patients.”

What doctor who truly wants to help people can survive in a cancerous capitation-payment system? When capitation was previously tried in Hawaii, its malignancy caused local medical groups to hemorrhage significant financial damages. Presently, some doctors are already succumbing to the pressures of capitation by walking away from their practices.

Many doctors are speaking loud and clear about being thrust into a position that could lead to hurting patients due to an insurance company’s bottom line taking precedence over people’s well-being.

Really, HMSA?

With capitation metastasizing among HMSA’s 3,000 in-network doctors, what chance is there that new or experienced physicians from outside of Hawaii will come here to practice medicine? This includes our state’s own keiki, who are completing their residency in the mainland, hoping to return home to practice. There is no incentive, no livelihood and no hope if this assault on the healing profession continues to escalate.

Hawaii is lucky to have a wise, respected and much older community in its midst. Add to that the baby boomer generation, aged 52 to 70 in 2016, who are the highest adult users of health care services. Our need for more – not less – highly skilled practicing doctors is obvious.

Many doctors are speaking loud and clear about being thrust into a position that could lead to hurting patients due to an insurance company’s bottom line taking precedence over people’s well-being. HMSA needs to go back to the drawing board in its newly renovated multi-million-dollar building with lavish bathrooms and find better solutions. Rethinking its budget appropriations for new construction would be a start. Perhaps members could pay adjustable monthly premium rates to HMSA – based on patient satisfaction. That’s our cost-containment, our bottom-line priority and our best interest.

As one practicing doctor recently sarcastically lamented to my office, “I will be happy when the insurance companies not only make all the rules for practicing medicine, but also are liable for the results.”

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