Follow the Money
The Sunday Minneapolis Star Tribune had an excellent article about a physician who performs house calls in the Twin Cities area. Dr. Edward Ratner obviously enjoys working outside the limiting confines of a clinic office and makes a convincing argument that it serves the patient better.
However, it is equally obvious that the health insurance plans are not convinced of the efficacy of this method of health care delivery. Julie Brunner, executive director of the Minnesota Council of Health Plans, has this to say:
“That’s a really expensive use of a physician’s time,” she said. As a practical matter, home visits by nurses or other caregivers are much more common and affordable, she noted. “We would all love to be seen by a physician in our home, but we’re being killed in health care costs in this country right now. There’s a crisis, so we may not have [that] luxury.”
Once upon a time the health plans would not reimburse EMS providers for on-scene treatment of hypoglycemic patients with no transport. Their reasoning was that it would not save health care costs. The fact is that paying EMS $175 for scene treatment, including a physician consult by phone, saves money by eliminating the ambulance transport, the ER visit and the physician charges. The Plans didn’t have a leg to stand on and eventually started to pay – but the lesson is instructive.
What the Plans don’t want (or any other provider, for that matter) is to lose a revenue stream. With regulations and reimbursements the way they are, providers have learned how to “make it” with volume. High volume, even though accompanied by low reimbursement, is doable. Cut into the volume, however, and the system begins to be stressed.
So it is not at all surprising that health plans are leary of physician house calls. It has the potential to cut volume.
The chase after reimbursements is one of the biggest problems in health care and its genesis has been due to over-regulation, chiefly by government.