Goals:
1. Eliminate the multi-tiered insurance-run pay system, which oppresses those providers without the initials "M.D." or "D.O." after their names.
2. Increase pay rates by as much as 50% for all procedure codes, as well as add annual cost of living pay increases.
3. Require all insurance panels to give at-cost health insurance to its providers.
4. Health care parity, placing the doctoring back into the hands of practitioners by allowing payments for all diagnoses, not limiting numbers of sessions/visits, and the eradication of treatment plans/reports and the requirement for prior authorization.
5. Penalty payments of at least 125% of the contracted amount, on correctly billed allowable visits that the insurance companies did not pay for. Results: So far all attempts by Provider Parity have not worked to organize providers, no matter how overworked or interested in being able to do more for their patients that the providers have stated being. Fortune had an article about women and being fearful of "rocking the boat" that may explain a lot about this phenomenon: "(Fortune) -- Dear Annie: My sister, who is in her late 30s (as am I), is a super-successful salesperson, one of only two women on an 18-person sales staff. She recently found out that she and her sole female colleague make about 20% less than the men, even though both women are highly productive "stars." I think she owes it to herself to talk to her boss about this, but she says she's satisfied with her current pay and doesn't want to "rock the boat." Should I butt out and mind my own business? What do you think? - Just Cathy
Dear Cathy: I think that women's unwillingness to "rock the boat" is a big reason why, according to the Economic Policy Institute, the wage gap between college-educated women and their male counterparts has actually gotten bigger since the mid-'90s. A decade ago, women earned 75.7 cents for each dollar paid to a man. Now it's 74.7 cents." Actually, ~75 cents per dollar is a lot compared to how the HMOs have set things up, forcing providers in the female-dominated groups to see up to twice as many patients as they otherwise would have to, thus allowing for far less case prep work, research into the medical conditions and latest advances, etc. Ultimately the "savings" forced by HMOs end up costing patients a lot more in their medical care compared to what is otherwise possible. Ask your insurance company to cease sexist pay scales and treat all medical providers as the professionals they are. | The Story: The main issue is that HMOs control how above and beyond that providers can go for patients, primarily by setting pay rates lower for groups of providers that are primarily women. For example, in the mental health field, years ago it wasn't uncommon for therapists to get together in meetings to discuss cases (w/o including identifying information, due to privacy concerns). This made it so that therapy patients would not have to rely solely on the beliefs of that one therapist. Therefore, each patient had a team of expert minds behind their treatment, but when psychologists came along, a new lower paying tier was developed by the HMOs for the same therapeutic procedures, even though psychologists typically have no less, and sometimes more, training than psychiatrists (M.D. therapists) in psychotherapy/counseling. Psychologists are doctors who have a much greater percentage of women than psychiatrists. When D.O.s came along, doctors of osteopathy, a heavily male dominated type of doctor, in time their group got equal pay and respect with psychiatrists. Next came along Licensed Clinical Social Workers. While some had much less therapeutic training than the first groups, some would attend multi-year trainings in analysis or other advanced forms of therapy to have even more training, yet this vastly female-dominated group managed to only get a small fraction of the pay of psychiatrists (for instance, Medicare currently pays them 50% for the same exact procedures as their M.D./D.O. counterparts, while psychiatrists can get even more for doing psychotherapy and medication at the same time). Further groups came along, such as Licensed Marriage and Family Therapists (LMFTs), specialists of working with couples and families, but HMOs sometimes do not cover couples, and while HMOs promote family therapy, due to the extensive research into how effective it is (particularly with children, rather than just trying to "fix the kid"), they pay these top experts in family therapy at as little as 1/2 of that which psychiatrists, and still less than psychologists for the same procedure (90847 = family therapy). This low pay rate has discouraged many of the seasoned LMFTs to do little family therapy, regardless of how effective it is. |