Rich Woller: Pay medical providers 100 percent for 100 percent effort


LENOX — As a relatively new advanced practice provider (APP), working as a physician assistant (PA) in a faculty practice at a community hospital, it has come to my attention that certain insurance carriers reimburse my employer at 85 percent of the rate of what a physician would be reimbursed.

Now on the surface of this little truth it may appear that it makes sense to reimburse less because PA's and nurse practitioners (NPs) don't have the same in-depth education and training that physicians have. Of course, that raises some very thorny issues.

The first question to arise is this — are APP's providing patients with 85 percent of the care they deserve? That can't be right. Why would a patient see a physician assistant or nurse practioner if they thought they weren't going to get top notch 100 percent care?

It's not as if an APP would put in 85 percent of the sutures called for when repairing a laceration or draining 85 percent of the abscess to help clean an infection. Is my medical history taking 85 percent of effort when evaluating a patient's abdominal pain, headache or fatigue? Do I execute only 85 percent of a patient's physical exam?

Of course not. APPs go all out — maybe 110 percent to diagnose and treat their patients. That's what we signed up for.

By law, PAs have supervising physicians, but many of us work very independently. I do check in with my physician partners from time to time about cases as they often do with each other. That seems like it should be reimbursable at 115 percent since in essence the patient is getting the expertise and advice of two medical practitioners instead of one.

So where do these rules and policies come from? Who makes these seemingly arbitrary and ridiculous rules adding to the already overly burdened health care system? The answer — Medicare, one of the finest government programs ever to be set in motion by the U.S. government, but unfailingly bureaucratic.

100 percent for execs

Adding insult to injury, the universal Blue Cross Blue Shield insurance plans followed suit. Many other private insurance plans reimburse APPs at 100 percent, which begs the question? Are the senior executives and overseers of Medicare and BC/BS plans working at 85 percent intellectual capacity or effort? These executives are usually the ones with all sorts of fancy advanced graduate degrees from Harvard and Stanford and other elite institutions of higher learning. Can they really be that dumb? Unlikely. You need high SAT scores to get accepted into these institutions.

It's demeaning to know that these powerful government agencies and large, private insurance companies making millions of dollars in profits can get away with paying APPs less for 100 percent effort in the delivery of care. Fortunately, my patients don't have to worry. Just today, my office staff and I gave 200 percent to get one of our patients a medication she needed expediently, but could not afford. For those who don't know, not all the pharmaceutical companies are bad apples.

If this unequal pay for equal work sounds familiar, it is. More than a few studies consistently point out that women still lag behind men in compensation for equal work. Can't miss the similarities here since by far the majority of APPs are women — another example of our country's institutionalized gender bias.

This really is a sickness. I'm thinking of ordering a CT scan to look for calcifications and shrinking ventricles in the institutional brain, all signs of government and industrial dementia on an issue that is without doubt, curable.

Rich Woller is an occasional Eagle contributor.


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