Reform must let doctors be doctors

This article is the archived version of a report that appeared in the August 2009 Consumer Reports magazine.

As a family doctor in a 70-person practice affiliated with Thomas Jefferson University Hospital in Philadelphia, Victor A. Diaz Jr. grapples daily with irrational insurance coverage rules. For example, many insurers will cover only 15 minutes of a doctor's time for follow-up visits, he says. "We're doing such a great job of helping patients live longer that they get to be older and develop co-morbidities like arthritis, high cholesterol, diabetes, depression," Diaz points out. "If you're going to address those issues, plus things like cancer screening, you'll never get everything done in 15 minutes."

Then there's the question of group-visit therapy. Diaz and his colleagues find it's an excellent way to encourage people to lose weight, eat smarter, and take up exercise—all things that could really help improve their health. But "the insurance billing code for group visits is ill-defined," he says. "To get reimbursed, we see each patient individually first, and then we gather them together in a group."

Diaz adds that as a salaried faculty physician, he can leave the billing and collection headaches to others. His colleagues in private practice can't always do that. The cumulative effect, he says, is to drive medical students away from primary-care medicine and into higher-fee specialties just to pay off their medical school debt.

CU recommends

Many people's idea of good care is a super-specialist using the latest high-tech equipment. But what most people truly need is a dedicated family physician like Diaz. Such a doctor would keep you healthy as long as possible and manage any chronic conditions. Just as important, he or she could coordinate any specialist care you might need—which would help the "episode of illness" payment system described in the previous section.

Not that we have anything against specialists. They're essential. But as Consumer Reports noted in its July 2008 report "Too much treatment," patients in areas with a lot of specialty care actually fare worse than those where primary care is more common. In fact, if the focus were on primary care throughout the U.S., costs would drop an estimated 20 to 30 percent.