On the heels of today's earlier post re: P4P and how many doctors feel it's a push by insurance companies to drive down costs with little regard to quality, I ran across this article on UnitedHealth's mandates for lab tests and procedures.
One concern voiced is over a "facility fee" that UH dropped which paid gastroenterologists to do certain procedures in hospital or ambulatory surgery centers:
Edward Cattau, chairman of the national affairs
committee for American College of Gastroenterology, says that while
some procedures can be safely performed in offices, there is far less
state oversight compared with hospitals or surgery centers. Doctors
should decide, he says, where to do procedures.
Connecticut doctors say the move amounts to a
30% pay cut because most doctors prefer to do the procedures in surgery
centers or hospitals.
"We do see it clearly as an attempt to drive things into the office purely based on finances and not safety," says Cattau.
"[A]t what level should a health plan be able to dictate where medical
services are provided?" asks Jeanine Freeman, senior vice president of
legal affairs for the Iowa Medical Society.
For its part, United calls this particular rule "an acknowledgment that it costs a doctor more to do them in-office."
