Reimbursement limbo pushes doctors lower and lower

AMA Leader Commentary. By William G. Plested III, MD, Oct. 6, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from William G. Plested III, MD, chair of the AMA Board of Trustees.

Do you remember the West Indian dance, the "limbo"? The one where dancers try to pass beneath a bar that is periodically brought closer and closer to the ground? As the dancers bend farther and farther back, spectators chant, "How low can you go?"

For at least the past decade or two, American physicians have found themselves to be unwilling contestants in a special "limbo" contest.

We have found ourselves forced to accept lower and lower reimbursement for our services -- even as overhead costs, such as medical liability insurance, skyrocket. However, this limbo is not a game. The contest is deadly serious, and it is systematically driving our health care system into chaos.

As the art and science of medicine begin to move steadily toward the science side of the equation, physicians and patients rely increasingly on sophisticated and expensive technology -- with costs rising at a sobering rate. Add to this an aging population and the inevitable result has been -- and will continue to be -- striking increases in the cost of health care delivery.

A brief look at the armamentarium of the physician in 1950, compared with that of today's physician, offers dramatic proof of the reason for these increases.

For various reasons, health insurance in our country has been provided primarily by employers (in the form of insurance) or the government (in the form of Medicare and Medicaid). This effectively places a third party between patient and physician. These third parties have garnered more and more power in the patient-physician relationship. They have the power to affect the frequency, duration and content of a patient's visit to his or her physician, and they also have the power to determine the choice of treatment.

In addition, third parties actually pay for physician services, as well as hospitalization, tests and drugs. The old system, where patient and physician determined payment, was believed to be inflationary. The patient always wanted the best possible health care, which is often the most expensive. And the patient's physician was ethically bound to provide the very best care.