Viewpoint
Rejecting Trickledown
Health Care
From the Chief Medical Editor
We can all conjure up plenty of words and images
to describe how we feel about managed care. For
the sake of making our point here, let's go with the image of a funnel.In today's model, the Health Care Financing Administration sits atop the funnel, sending dollars down to HMOs, which take a cut for themselves. Then, the money flows to the HMOs' regional affiliates, who are managing the contracts, and they siphon their profit from the flow. By the time the flow of funds reaches us, the ones providing the care, it has been reduced to a mere trickle. Under a lot of contracts, if we're lucky, we're paid only 50% of the Medicare allowable for our services.
As this trickledown system continually erodes our ability to provide quality care, it can leave us wondering if it is even worthwhile to provide the care. But it doesn't have to be this way. A growing number of ophthalmologists are rebelling against this misguided way of delivering medical care.
A framework for breaking away
In this month's cover story, we hear from Dr. Thomas Pusateri, a Florida ophthalmologist whose practice took a bold step in January of last year. He and his fellow practitioners began systematically dropping out of managed care plans that were suffocating them, preventing them from providing the kind of care their patients deserve.
It hasn't been easy; at times it's been scary. But the doctors and staff members now see signs that the practice is better off. They're happier, making better use of their time. Patients are happier, too, and plans for growth and improvement are under way.
They've regained control of their practice. No longer are they faced with the dark sides of managed care like fearing forced capitation or being booted off a panel because they're performing surgeries they deem necessary. For them, managed care no longer has to mean denied care.
If only more of us could take the plunge and figure out how we can make similar changes in our practices, we just might turn the tide against trickledown health care.
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