A Modern Country Doc–playing the game

Tom Bibey

The insurance companies love to play doctor. Take my noncompliant diabetic patient with a hemoglobin A1C that does not meet goal. (We explained this in an earlier blog post.) The first order of business, since I wish to stay in practice, is to send him to an endocrinologist. If possible, one should bolster the case by the choice of one from a medical center. A year later, the patient will still have the same numbers, unless he comes to Jesus and decides to change his life. The cost of the endocrinologist changed nothing but increased the bill to insurance, and my risk as a target for the blame is dramatically lowered due to the referral.

 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Here Dr. B is referring to our effort to meet certain treatment goals with patients. Some insurance companies reimburse physicians with extra money if a certain percentage of their patients reach the recommended goals. This is called Pay for Performance and sometimes referred to as P4P.

A large randomized controlled trial on diabetes–ACCORD— helped to outline the goals management of  patients with Type 2 diabetics. Here is an easy explanation.

The challenge is to motivate patients to change their behavior, often easier said than done. In earlier posts we’ve talked about Motivational Interviewing techniques to help patient weigh the pros and cons of continuing to do what they do. As you spend time in clinic, you’ll see different attempts to help patients quit smoking, lose weight, start exercising, be compliant with their medications. It is no easy task. However, I don’t want to leave you with a downer. When you do assist someone in making a behavior change, there is nothing like it—it can make your whole day or week for that matter.

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