LIFE GOES ON: Protect Yourself and Be Your Own Healthcare Advocate

DEAR DOCTOR KATHLEEN,

I have a mother’s intuition that something is terribly wrong with my 2-year-old daughter. She is lethargic, doesn’t make eye contact, and doesn’t  interact with other children. Her pediatrician says she is just shy and will outgrow this. What should I do? He will not refer me to a specialist.

I KNOW SOMETHING IS WRONG

DEAR I. K.S.I.W.,

We need to be our own health own health care advocates and researchers. We need to stop being “GOOD GIRLS”who listen passively to doctors who don’t listen, don’t trust us, and don’t take our concerns seriously. I’m sure your intuition is correct. A mother knows. Your daughter may be on a developmental spectrum that is best treated immediately. There are BIRTH TO THREE treatments that make huge progress compared to later treatment. Agencies in Connecticut such as www.creativeinterventions.com change the lives of children and parents. INSIST. You do not need to get your doctor’s permission or approval. Listen to your intuition. Get her the help she needs. Be her advocate.

And as for physical illnesses, HMOs are sometimes rewarded with $$$$$$$ for NOT referring for further testing. The following was from a CBS report I found on the Internet:

“Health care systems have a budget,” says attorney Stephanie Kanwit, who represents many of the country’s biggest HMOs and has written a brief for the Supreme Court explaining the HMOs’ position in this case. “And doctors have to be participants in trying to hold down costs. Who better than to hold down costs than a doctor who’s making judgments?”

For holding down those costs, doctors can make a lot of money. At one Humana HMO, the doctor’s contract spells out very clearly that if a physician can reduce the cost of medical services such as lab tests and outpatient surgery, his or her bonus goes up dramatically.

For example: If those services cost an average of $36 per patient a month, the doctor’s bonus is 25 cents per patient. If the cost of the services drops to $24 a month, the bonus jumps to $1.25 per patient. Under this system, a doctor with 1,500 patients, which is not unusual, could make an extra $18,000 a year. There are also other bonuses – for reducing drug use, hospital visits and surgery. The total bonuses can amount to tens of thousands of dollars a year.

Kanwitt says that this system is a good way to hold down costs. “We all have to work for money and think about cost,” she says. “The small business, Ma and Pa grocery store owner, has to think about money. Why should physicians be exempt from those rules of the marketplace?”

“It’s not a conflict of interest because theoretically what’s best for their patient is also best for the bottom line in the sense that they’re delivering quality, but also cost-effective, health care.”

Other doctors disagree. “(It is) an absolute conflict of interest – absolute, if you’re giving money to not treat your patient,” says Dr. Harvey Wachsman, a neurosurgeon and lawyer. One of the most successful medical malpractice attorneys in the country, he has made a career out of fighting HMOs.

“These incentives destroy people,” Wachsman says. “That’s the point. I am all for America. I’m all for incentives. I’m all for people making money. God bless America. But I’m not for seeing to it that they destroy people, and that’s the incentive, to see to it that a physician doesn’t do what’s right for the patient, doesn’t treat the patient, but avoids those things which will help the patient, so that he makes a few paltry extra dollars for doing that.”

The American Medical Association joined in the fight against Herdrich’s lawsuit.

Kanwitt says that 60 percent of doctors who work under managed care plans get some kind of incentive, including bonuses.

Wachsman says the Herdrich case is important because until now it has been very difficult under federal law to sue HMOs. “How do you make (HMOs) accountable?” asks Wachsman. “The simplest way is when it hits them in the pocket.”

Malpractice suits have made some lawyers, including Wachsman, rich. His critics say he’s just trying to pick the deep pockets of the HMOs.

On June 12, the Supreme Court decided in favor of the HMO.

Writing for the unanimous court, Justice David Souter said that financial incentives are essential to the survival of HMOs. Changing that structure, he wrote, would effectively eliminate for-profit HMOs.

That case is only one of several fronts in the war over managed care. Other lawsuits against HMOs accuse them of violating a racketeering law by concealing doctors’ financial incentives to hold down treatment costs.

A number of states have enacted their own laws barring managed-care plans from giving doctors bonuses for providing inadequate care. Congress also is considering patients’ rights legislation that could set new standards for managed care and might broaden patients’ right to sue their HMOs.”

NEVER TAKE NO FOR AN ANSWER. TRUST YOURSELF. BE WISE.

LIFE GOES ON©

Kathleen Cairns, Psy.D. is a licensed clinical psychologist in private practice in West Hartford, Connecticut. She works with adults, adolescents, and couples. You may call her at 860-236-5555 to make an appointment. She is the author of “The Psychotherapy Workbook.” You may email her at kathleen.cairns@mac.com and she will try to answer as many of your questions as possible.

www.kathleencairns.com

Life goes on… and every day matters…

[ad#uconn468]

 

Similar Posts:

Share

2 Comments on "LIFE GOES ON: Protect Yourself and Be Your Own Healthcare Advocate"

  1. Preliminary results indicate 9% rate increase in 2011 for HMOs, 11% for PPOs–higher rate than recent years. http://www.healthcaretownhall.com/?p=2910

  2. Thank you for your article. It is very similar advice to a book I recently read, ‘Life in the Deadly World of Medicine’ written by Joseph T McFadden, which stresses the importance of advocating for oneself and loved ones while faced with any medical issue. That book was a real eye-opener.

Comments are closed.