01/20/2014    Jack Sasiene, DPM

Have you recently been dropped from an insurance network? (Matthew Garoufalis, DPM)

First, let me thank Dr. Garoufalis for responding
in this forum. I hope all of you reading out there
take the time to let him know how you really feel.
One can not do a good job leading unless they get
input from the members. Just grumbling and
following does nothing.

I think after reading the string of comments on
this and many other impediments to practice, that
doctors, not just podiatrists, are fed up with the
business of medicine. The issue is not podiatry
here but the fact that we can’t be, for the most
part, doctors. Between ICD-10, meaningful use, and
now the attestation audits, insurance plans
thinning its providers to limit patient
utilization, and us being contract labor, we’ve
all just about had enough. To all this, Dr.
Garoufalis states the following:

“APMA has been diligent in sharing information
with members about provider terminations,
narrowing of provider networks, and managed care
contracting through its various communication
vehicles, including APMA News, APMA.org, APMA
Weekly Focus, and APMA News Brief.” and
“Because the vast majority of members’ concerns
have been focused on Medicare Advantage
Organizations’ termination of provider contracts,
APMA has created a wealth of resources on that
topic.”

It is obvious from the results that the above has
not resulted in effective action by the APMA.
Telling us that all this is happening, how to
manage those situations and sending letters, at
the very least is thoughtful, but it obviously is
not helping the bottom line for those in full time
practice.

Take the current issue of ICD-10. We are told by
“leaders” in our profession after doing everything
right, the insurance industry may not crosswalk
the codes correctly and payments will be
delayed…….having to hold onto patient premiums for
awhile. No conflict of interest there. What would
the retail industry do if credit card processors
said they were changing the processing of charges
and it might result in a 6 month delay in payment.
I think they might tell them to get it right
before instituting it or they won’t take credit
cards. We are told: to put aside up to 6 months
of overhead! That would be about $240K for
me...really?

There is a disconnect here between those of us
working on patients for a living and those leading
us. Those who want a one payor system for
simplicity are on to something…..it should be the
patient!

The only way doctors will get back control of
their practices is to work for themselves, not
insurance companies whose only concern is money.
It is not about making a ton of money but doing
more than staying a float and paying our
employees.

The APMA AND AMA with a powerful lobby, need to
act in an interest consistent with doctors being
able to provide the best care for their patients.
Take that bold step Mr President and inform your
colleagues how best to take control of their
practices, not how to continue to work within a
system that is failing. We will still need the
APMA for many other issues after we aren't working
for the insurance companies.

Jack Sasiene, DPM, Texas City, TX,
Sasiene@aol.com

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