Greedy medical specialists refuse to treat most children with serious health problems if they have public insurance
Dr. Alexander Stemer said he will remain president of what will now be called Franciscan Medical Specialists. The group’s employees will remain, and they will maintain all of their benefits, Stemer said. Aside from the new name, patients will not notice much change. The offices will maintain the same services. “There will be no apparent difference from the standpoint of the patient,” Stemer said. Gene Diamond, CEO of Franciscan Alliances Northern Indiana Region, said the physicians group is a good match for Franciscan. We’ve been chatting with these folks for years, he said. The reason we have persisted is because Alex (Stemer) himself and, obviously, the group he has led have established a pretty obvious excellent reputation for high quality. Given Alex’s abilities and his vision, it was pretty clear to us that this would be a good match. Stemer said Franciscan Medical Specialists will serve as a specialty arm in the northern region, recruiting and placing university-qualified physicians where they are most in need. The land beneath our feet in health care is shifting, he said. We’ll be looking for physicians looking to join larger organizations. Aside from his role as president, Stemer will work in strategic planning in the northern region. Diamond said Stemer already is beginning to work with Franciscan on its accountable care organization in the northern region. Medical Specialists was established in 1978 and has 12 locations in Lake, Porter and LaPorte counties. Its team consists of 55 physicians and surgeons, 11 nurse practitioners and two physician assistants.
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Putting a price tag on contacting your medical specialist
But if youngsters with identical health problems and symptoms had the higher paying private insurance, they were turned away by doctors only 11 percent of the time. “We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance — even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children,” senior author Karin V. Rhodes, MD, MS, director of Emergency Care Policy Research in Penn’s Department of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, said in a media statement. What’s more, the study also uncovered facts indicating that some specialists apparently think they can thumb their noses at federal law which is supposed to require that Medicaid recipients have the same access to medical care as the general population in their community. Bottom line: the researchers found that Medicaid and Children’s Health Insurance Program (CHIP)-insured children who were able to even get an appointment with a specialist had to wait far longer to be seen than kids with private insurance. It almost sounds like the specialists are inflicting a kind of punishment on kids who have the “wrong” kind of public insurance that doesn’t pay the doctors as much in reimbursements as private insurance. Sick kids with Medicaid or CHIP had to wait over a month, about 44 days, for help. But privately-insured children with similar urgent conditions were seen in less than three weeks. For the study, research assistants compiled facts by working undercover — they posed as moms of children with seven common medical that affect large numbers of children and are serious enough to need timely specialty care: severe body rashes, obstructed breathing during sleep, Type 1 diabetes, uncontrolled asthma, severe depression, new onset seizures and a fracture that could affect bone growth. The researchers, pretending to be mothers, placed calls to a random sample of 273 clinics representing eight medical specialties in Cook County, Pennsylvania. Each of the investigators placed two calls, separated by one month, to each clinic using a script that varied only by insurance status. Only 34 percent of callers with Medicaid-insured children were told they could even get an appointment with the specialist. But if the researchers-posing-as-moms claimed they were calling about a child with Blue Cross Blue Shield PPO insurance, 89 percent were given appointments. It was obvious that how the doctor was going to get paid — whether by higher paying private insurance or by lesser paying public insurance — was of far more importance to the specialists’ offices than the severity of the child’s reported symptoms.
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The institute’s Select level costs an extra $500 a year. For that sum, patients will receive “priority appointments” for certain treatments, such as pacemaker maintenance, and “prompt notification of non-urgent test results.” Presumably, if you don’t pay the extra money, you’ll get your pacemaker adjusted at their convenience, and word of your test results will arrive in a less-than-timely manner. For $1,800 a year, institute patients can enjoy Premier status, which buys them everything Select patients receive plus “priority scheduling of diagnostic tests” and “direct email and phone communication with your personal cardiologist.” I’m sorry, but for people with a heart problem , you’d think every diagnostic test is a priority. Moreover, since when is it considered a premium service to be able to reach your doctor by email, especially if you have a chronic condition? The institute’s top-drawer Concierge service runs $7,500 a year and provides everything the other levels offer, as well as 24-hour pager, email and cellphone access to your doctor and “emergency night and weekend availability of your personal cardiologist.” I spoke with Oppenheim’s cardiologist, Dr. Richard Wright, who acknowledged that a doctor at his practice will always be available if a patient has an emergency. “But if you want me, and it’s my weekend off, that’s now purchasable,” he said. “What we’re telling patients is that if you want additional access, that’s an option.” From a purely dollars-and-cents perspective, Wright makes a case for premium levels of healthcare. Many of his patients are covered by Medicare, he said, and the federal insurance program has lower reimbursement rates than many private insurance plans. It’s not economically feasible, Wright said, for him and other doctors at his practice to take every patient call or respond to every email. In many cases, he said, nurses or nurse practitioners can just as easily handle these communications. But if a patient wants to pay extra for a higher level of access, Wright said, then that possibility should be available. “This is a mechanism for the doctor-patient relationship to survive,” he said.
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