Opinion
Insurers misuse wellness programs
LETTER — Posted April 21, 2008
Regarding "Getting paid for prevention: Physicians facing coding challenges" (Article, March 24/31): Smoking cessation is one area of patient care to which I pay particular attention. I have found counseling quite effective in getting my smokers to quit. But despite two years of billing for it, and utilizing every billing/coding tip from various journals on the subject, not a single payment has ever been rendered to me for this service.
There is something fundamentally wrong with a system that will pay me to treat my patients for COPD but not to support them in giving up a three-pack-a-day habit. Likewise, our system pays readily for dialysis and amputation but not for the time- intensive primary care needed to keep our diabetics well controlled. Our system thus rewards poor management rather than prevention of complications. More tips on billing and coding will not fix the underlying systemic dysfunction.
The wellness programs you describe are really just insurers' way to deny reimbursement. When you aren't ordering enough HbA1c tests (actual reduction in HbA1c is not tracked, just how many tests you get) or doing enough inappropriate Pap smears (women who have had hysterectomies often come up on the lists as deficient in preventive testing), they state that you haven't met quality guidelines and do not qualify for their bonuses. More testing does not equal quality health care, but it certainly pays better.
Alicia Skarimbas, MD, Great Barrington, Mass.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/04/21/edlt0421.htm.
