LETTER TO THE EDITOR
SENT TO THE PLAIN DEALER
BY THE AMC/NOMA

The recent articles regarding fees charged by a medical practice failed to point out that physicians are restricted by laws that limit reimbursement for their care and yet, overhead costs continue to accelerate. Physicians pay overhead costs that include rent, staff salaries, and health insurance benefits - just like any other business.

When physicians' sign a managed care contract they do their level best to adhere to the provisions of that contract. However, insurance and government regulations require time consuming tasks on physicians' staff such as pre-certification of tests, surgeries and procedures. Doctors spend countless hours fulfilling these requirements through endless phone calls, faxes and paper trails - all without additional reimbursement. One would think that the health insurance company itself should have to pay for complying with their own requirements - but they do not. Has any patient noticed a decline in his or her health care insurance premium lately?

Tort reform legislation is only the beginning. Physicians must be given the right to negotiate with the insurance companies. There are federal laws that exempt insurance companies from antitrust scrutiny. This means that these are allowed to share information including reimbursement schedules - but physicians cannot. This allows certain insurance companies to dominate markets and force one-sided "take it or leave it" contracts upon physicians - and it also allows these companies to dictate to physicians how to run their practice.

If an individual physician makes a personal decision to charge a fee to their patients to continue providing medical services or stay in practice, and it does not violate a managed care contract and it is not illegal, that physician should be able to notify their patients of this decision and give them their payment options. And, they should be able to make this decision without being vilified in the local newspaper.

The cost for running a medical practice escalates every year, yet the reimbursement rates from insurance companies continue to decline. If this trend continues many other physicians will be faced with decisions regarding their practice - not only as it relates to charging practice administration fees but whether or not they can continue to practice. The only way to avoid this problem is to level the playing field for physicians and allow physicians to jointly negotiate with insurance companies on behalf of our patients.

Sincerely,

Kevin T. Geraci, M.D.
President