Texas physicians voice time, pay frustrations

Doctors say their pay is going down but the hassles continue to increase.

By Emily Berry — Posted Feb. 23, 2009

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A survey of Texas physicians reflected challenges that physicians across the country face, particularly in feeling cheated on time with patients because they have to chase payments.

Among the Texas Medical Assn. survey results: 93% of the 849 doctors who responded said insurance companies take too much of their time. Nearly that many -- 87% -- had the same complaint about Medicaid, Medicare and Tricare.

The problem has shown up in TMA's past surveys and has increased, said Albert Gros, MD, an ob-gyn from Austin, Texas, and chair of the association's legislative council. "The gist has always been the same, and the fact is the majority of the doctors are contracted with health carriers. It's getting harder and harder for them to play ball with these carriers."

Pay is shrinking as hassles grow, respondents said. Compared with 55% who reported a decline in practice income from 2004 to 2006, 61% said they were making even less in 2008. Another 28% said they'd seen no change in income over that time -- despite an average inflation rate of 2.8% in 2007 and 3.8% in 2008.

The TMA isn't alone in trying to address insurance hassles. The results of TMA's survey echoed problems the American Medical Association made the target of its "Heal the Claims" campaign, launched in June 2008 along with a report card grading each health plan's record of accurate and timely payments.

Dr. Gros said TMA plans to take its most recent survey to state legislators, who will be considering changes to insurance regulations this year.

Though many of the issues aren't new, the Legislature's party balance is more even this year, opening up new possibilities for organized medicine to make its case for change, Dr. Gros said.

Beyond the hassle and time demands of trying to get paid, Texas physicians who responded to the recent survey said patient care was suffering, both from the delays and payer policies.

Fifty-six percent of respondents reported at least one time when an insurer's utilization controls hurt patients.

The nature of those problems has shifted, Dr. Gros said: "It used to be out-and-out denials. What we're seeing now is services are covered, but we find out patients have high co-pays and deductibles, and even though they are authorized, the patient then finds out they've got a huge out-of-pocket cost, and that affects their decision to get care."

Robert Zirkelbach, spokesman for the national trade group America's Health Insurance Plans, said insurers have been working to streamline the claims process and make it easier to get authorization and reimbursement.

Those efforts include increasing the number of claims paid electronically, adopting real-time claims adjudication and supporting other time-saving technological changes, such as e-prescribing, he said.

"I think it's something health plans have continually been doing, as new technology has been developed," he said. "Right now you're seeing a lot of collaboration between health plans and the physician community ... it's in everybody's best interest to do these things."

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Biggest challenges

Texas physicians were asked, in a Texas Medical Assn. survey, to identify their biggest challenges. Most noted money issues.

Payment 29%
Economic survival 15%
Medicare/Medicaid fees 13%
Uninsured/underinsured 10%
Insurance companies 7%
Third-party interference 5%
Liability 4%
Quality/access 3%
Physician supply 2%
System reform 2%
Texas Medical Board 2%
Other 8%
Total 100%

Source: Texas Medical Assn.; about 10,000 doctors received the survey; 849 completed it.

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Making less

Six of 10 physicians in Texas reported that their income declined in 2008, according to a Texas Medical Assn. survey.

2006 2008
Increased 16% 11%
No change 29% 28%
Decreased 55% 61%

Source: Texas Medical Assn.; about 10,000 physicians received the survey; 849 completed it.

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