Pay Now, Save Later

Insurers, federal and state government agencies nationwide are experimenting with paying physicians, internists, and pediatricians to devote more time and attention to patients. The hypothesis predicts that insurers and patients both can save thousands of dollars on tests, visits to specialists, and avoidable trips to the hospital.

Currently, Medicare and other insurers pay an average of $60 nationwide to visit a primary-care doctor and it is nearly unheard of to compensate for telephone or e-mail consultations. This results in few-minute visits with each patient. One experiment in metropolitan Philadelphia includes paying physicians their standard fees (~$64/visit) but includes $200,000-$300,000 to a group in addition to regular fees to better keep track of their large pool of patients. This prompts doctors to try to do more e-mail and telephone care, which hasn’t been paid for in the past. Insurers are conducting similar pilot programs in a half-dozen states with thousands of doctors and nearly 2 million patients.

Some experiments include the hiring of additional staff to help monitor treatment and follow-up and to help patients stay ahead of problems by increasing reminders of preventative tests such as mammograms and colon exams. Chronic illnesses, such as diabetes, are better taken care of when doctors can afford now to take personal charge and answer phone or e-mail questions promptly. Patients also have the ability to show up on short notice in the office in case of an emergency and be seen. The ideal is creating a “medical home” or base where doctors, staff and patients create a health-care family as a vehicle for pulling Americans together from the inefficient “swamp”, according to Dr. Arnold Milstein.

 Milstein, a senior consultant at Mercer and a member of the Medicare Payment Advisory Commission, an independent Congressional agency, and the panel recommends that Medicare expand its plans for a pilot project next year. The current plan includes paying primary-care doctors in eight states $30 to $40 extra each month for each person enrolled with a chronic illness. Supporters of this plan hope it will help propel doctors into the pipeline of primary-care physicians, which is looking dry much like the pipeline for endocrinologists. Here, here ... we certainly need better reimbursement for anyone taking care of people with diabetes ... as well as better pay for phone calls and emails./span>