Secrets of the City

Well, I guess I can kiss my thorazine goodbye.

Then just be depressed. There are real reasons. Your depresion is justified Tombartell. Say no to drugs and Elvis doctors.

The Strib found only one doctor who is doing this. I know psych care is becoming less affordable and, at the same time, less profitable. But as it’s written, this seems like a case of a few opting out versus a trend in healthcare.

Good. I hope more doctors do this and that it forces some real change in the system, which is broken in just about every place.

Actually, Molly, the Strib quoted three doctors who were doing it and said there were about a dozen. This isn’t the only specialty where this is happening, btw.

Doh! Yeah, uh, I meant three, but one of them has been pay-in-full for at least seven years. And I know it’s not the only specialty where it’s happening. But the story left me with more questions than answers.

Try Canada.

Psychiatry, and behavioral health in general, has a host of problems. Reimbursements are low. Health plans push production (the 15 minute sessions). Health plans also “carve out” their mental health services from other types of care, creating more barriers and paperwork for both patients and providers. There has been mental health care equity legislation–originally sponsored by Paul Wellstone–languishing in Congress for years. It would force health insurers to treat mental health exactly like other health care. The legislation has a lot of bipartisan support. President Bush has said he would sign such a bill. Yet somehow it never quite gets passed. Curious.

For some reason, I blame Tom Cruise.

I agree with msparber.

Eith him or Dr. Phil.

I think the question here is that the doctors are beginning to realize that the patient-doctor relationship is being increasingly controlled by the insurance companies who are getting incredibly wealthy while screwing the doctors and the patients with ever lower fees and higher premiums, respectively. Drug companies seem to be doing fine, though, too.

“Increasingly controlled” is debatable. Physicians have actually gained back some of the bargaining power they lost in past years. Blue Cross recently announced plans to increase reimbursements to psychiatrists. The imbalance may still exist, but I’m not sure it’s getting worse in every case.

The real point here is what is the proper response to the imbalance? Is it to opt out of the system and ask your patients to pay upfront in cash? The psychiatrists in the story may have compelling arguments, but this approach surely won’t work on a large scale. Wouldn’t it be better if the provider community worked to address these issues in the political arena? Unfortunately, most physicians seem allergic to politics.

Mustard, ever asked a doctor what it takes to get paid by insurance companies? Many (most?) have to employ people just to file claims for reimbursement, and then argue that their claims are legit. Another layer of health care workers who have nothing to do with health care. Also, ever notice that the insurers are actually taking over the hospitals, and the doctor groups, and so are getting paid coming and going and the doctors often end up being their employees and making a lot less?

I’m pretty familiar with the Dr./Insurer relationship. Are you speaking of the U.S. health care system overall or just in this state? I’m not aware of health plans taking over hospitals in Minn (not in recent years at least). Physicians groups are a slightly different ball of tea, but even there I’m not hearing of health plans “taking over.” Our Attorney General has frowned on that, as I recall. Any examples?

More overall, but what will happen if Hatch loses the governor’s race and we have someone who can’t make political hay on the backs of the HMOs?

There are very few major hospitals in the Twin Cities that are not “run” by a health insurance or a “health service” group. North Memorial is one example of a independent hospital.

Some groups running hospitals and clinics and sometimes insurance too in the Twin Cities are Health Partners(Regions), Health East (St. Joes & St. Johns) , Fairview(Southdale, Ridge, & University of Minnesota), Park Nicollet (Methodist), Allina (Abbott NW, United, Unity & Mercy and Mayo (Mayo Clinic & most of southern MN).

“Health System” is different than “Health Plan.” And we were talking about Health Plans. HealthPartners/Regions is pretty much the last insurer/provider model in Minnesota. Allina and Medica split. Mayo decided not to run an HMO. North Memorial is indeed independant, but only in the sense it’s not part of a larger health system. With the Maple Grove hospital, it will be on the same level, or close, as some of the other systems mentioned. All of these systems, or provider groups, negotiate with health plans for contracts. They are not “run by” health plans.

It is clear that you don’t work in health care, Mr. Mustard.

I know that arguments and put-downs are par for the course on the Internet, but I’m confused about what’s being disputed here. Is it your contention that Fairview is the same as a health insurance plan? Or that health plans actually do control health systems in Minnesota? I don’t believe I’ve suggested that health plans have no influence at all on the practice of medicine. But the term “take over” certainly seems to suggest ownership and/or control.
So what is it you’re saying, exactly?

I guess having worked in the healthcare system, there is not much difference between how an insurance co. runs a care facility and how a health system like Fairview runs one. There are the same limits and layers that the caregivers have to deal with to try to do their job and help people.

Maybe I did not interpret the debate as literally as I should have. Forgive.