To the Editor:
Greg Bordonaro’s Dec. 1 article about “Tiered Network Medical Plans” is an excellent overview of an issue that we consumers, employers and providers of healthcare will face in the future. He does an excellent job of dissecting the marketing terminology and exposing their misdirection. Regardless of market pressure, it is dangerous to let the temptation of a lower price determine our level of health care. Purchasing health care is not like buying a loaf of bread.
When I read that insurers plan to “direct patients to efficient doctors and efficient hospitals,” the rhetoric is noble, but the reality will likely fall short. How do you compare doctors? By outcomes? The argument is not unlike what we hear regarding education today. It’s easy to make the argument that children with low grades on standardized exams are a result of poor teachers and failing schools. However, the main factor in a child’s achievement has been shown time and again to be directly related to the educational level of the parents and their socio-economic status.
Is health care any different? Will an inner-city doctor have a lower rating merely because of the educational level of his/her patient population and their socio-economic level? This begs the next question: Will it be to an institution’s advantage to carefully select their data and patient population in order to improve outcomes?
The playing field is intentionally uneven. Tier 1 is assumed to consist of the highest 20 percent rated doctors. But, according to Gil Keegan of Aetna, “Doctors left out of Tier 1 aren’t necessarily less quality providers, but they currently don’t have an [Accountable Care Organization] agreement with Aetna.” That’s misleading at best.
The article continues, “Tier 1 primary care doctors are incentivized to refer patients to Tier 1 hospitals and specialists” (and can share in the savings). Be it an incentive or kickback, it’s not the way I want my health care to be managed. When the bottom line in health care is the dollar, and the incentive is to provide less care at a higher profit margin, the patient is the loser.
Dr. Matthew Katz of the Connecticut Medical Society notes that, “There is no universal way of evaluating a physician for cost and quality.” Doctors, as well as the aforementioned teachers, know what is best for their patients (or students). Decisions of care need to be free of financial incentives, kickbacks and third-party involvement. It is up to us to demand this in advance, before the gurney wheels us into the ER and we are rejected for care because we don’t “fit the profile.”
Dr. Rick Liftig 10 Princeton Street West Hartford, CT 06110
