Copyright The Boston Globe
This is no way to address the primary care shortage Re “Physicians pressed to curb high billings: Blue Cross to scrutinize costly visits, threatens to reduce expensive charges” (Page A1, Oct. 26): As a recently retired physician who practiced internal medicine and primary care for 40 years, I was interested in Jonathan Saltzman’s article. In my experience in many types of practice settings (community health centers, the VA, my own private practice), I’ve found that the issue isn’t that “outliers” charge too much, as Blue Cross Blue Shield of Massachusetts asserts; the problem is that many physicians, at least in primary care, charge too little. At almost every visit, primary care doctors are expected to address the broad needs of the patient. Patients, appropriately, want their immediate concerns seen to and their questions answered, while at the same visit the physician is also expected to manage their chronic conditions, evaluate them for any mental health issues, and assess the need for any preventive studies or treatments (mammogram, blood tests, vaccines, etc.). This entails the doctor’s having reviewed the chart in detail before actually walking into the examination room as well as later reviewing test results and offering appropriate follow-up. It is the rare visit that doesn’t meet the standard of the highest level of care and merit the highest charge for that visit; yet most physicians are loath to charge at that level, partly because of fear of being told they are overcharging and, perhaps, partly because they have absorbed the notion that doing so is somehow wrong. Advertisement There have been many articles about the shortage of physicians, particularly in primary care, across the country. Undervaluing the work they do will certainly not encourage more doctors to meet this need. Dr. Roberta Berrien Dennis Instead of scrutinizing bills, insurer should dive deep into prevention The use of computer algorithms by health insurance companies is inevitable. But how they’re used can have positive or negative outcomes for health care. Blue Cross Blue Shield of Massachusetts plans to use the power of technology to find cases of overbilling on the part of doctors. Any focus on cost savings is good, but this approach is small ball, focusing on saving pennies (relatively speaking), and it may negatively affect patient care. What the insurer should be doing instead is analyzing claims that focus on prevention, taming exploding health care costs and vastly improving patient outcomes, so as to transform our broken fee-for-service health care system. Advertisement For example, every day patients in Massachusetts are being diagnosed with cancer, and the annual cost of their treatment can be as much as $1 million per year. What if computer analysis and even AI were used to examine the health care each cancer patient received over the previous years to determine which existing preventive treatments they did or did not receive? This review could find gaps in preventive medical protocols, and we could start developing these protocols in ways that our fee-for-service system fails to deliver, in order to save both money and lives in the future. Let’s be smart about deploying intelligence. Kevin Bowe West Newbury
