Yes! HMO (Health Maintenance Organization) medical care may in fact be the WORST thing that has ever happened to the healthcare industry. Why? Because, HMO’s will do whatever it takes to cut costs and that—in numerous circumstances–means cutting care. After my residency, I joined two ophthalmology practices that had large HMO contracts. My schedule was packed full of HMO patients who had serious diseases.
Yes, these SERIOUS diseases were neglected because patients couldn’t get authorization for necessary procedures, or their doctors had told them that they could follow up in 6 months when their condition should have been followed every 2-3 months. At one of the HMO clinics, my schedule had 65 patients a day and the office manager was planning to increase me to over 75 patient visits a day. I left that job at that point. The average compensation per patient visit was between 12 to 15 dollars maximum and that included all procedures. Yes, I did the math and calculus was my best subject in school. This is absurd and very disheartening when you consider that reimbursement rate in stark contrast to the hundreds of millions of dollars in the compensation packages of HMO insurance executives on an annual basis.
Why are HMO’s absolutely horrible for patients and doctors?
1. Patients will get much less time with their physicians. As a result, important historical information, signs, and symptoms will be missed. When there are 65 patients waiting for the same doctor in the waiting room on a given day, do you think you are going to get the attention you need for your condition as a patient? Will the doctor have time to answer your questions? NO WAY!
I saw a patient of a busy HMO practice one day. She was blind in one of her eyes. I told her that her eyes should be dilated since it was her annual eye exam. She said that she had not been dilated in her blind eye for over 10 years—since she had joined the HMO plan. “I can’t see out of that eye any way,” she said, justifying the neglect. I insisted that she be dilated. I asked her why she was blind in her left eye and she said that she was never sure, but doctors had told her that it was poor blood flow to the eye. I examined the blind eye and noted that her optic nerve was bulging at me. I immediately ordered an MRI of the brain (which still took weeks to obtain due to red tape and the inability of her HMO plan to authorize) which indicated that she had a huge brain tumor that was compressing her optic nerve in that eye and was growing towards her good eye. No one had taken the time to dilate her for all those years. But then again, these doctors were probably pushed to do whatever it took to fit in more patients and cut down the exam time per patient.
2. Patients have to wait to get important office visits and procedures authorized. Yes, you can wait in line for the “administrators” to say that it is okay for you to get surgery to repair your ruptured abdominal aortic aneurysm.
I had a patient on an HMO plan. She was a young 20 year old girl with an acute retinal detachment (you need this fixed ASAP). I sent her to the retinal specialist the same day. I called her the next day to make sure she was scheduled for surgical repair of her retinal detachment. She said she still didn’t get an appointment with the retinal surgeon because the HMO would not authorize it. I told her adamantly to forget her HMO insurance and pay cash for her visit. She went to the retina doctor, paid cash and had the surgery the next day. I saw her in follow up two weeks later and her vision was 20/20. She said “Doctor, do you know that my HMO insurance just authorized my retinal detachment surgery?” (Yes, the HMO insurance plan finally authorized the vision saving surgery two weeks after onset of her retinal detachment–a condition that should be surgically treated within 24 hours)
3. Physicians will waste valuable time fighting to get authorization for their patients. They will face burnout as they will have to double, or even triple, the number of patients they see. They will also be helpless should they get sued and cannot defend themselves when the patient who needed a test didn’t get it in a timely fashion. “The HMO wouldn’t authorize the scan and the patient died of a ruptured aneurysm. What could I do?” “Well doctor, you could have stayed on the phone for four hours a day and written dozens of letters in your free time to get that authorization.”
4. Doctors who don’t give a hoot will get financial rewards. The doctors who don’t order tests that patients need, who don’t do procedures that will help their patients, and who tell patients that they don’t need to come in for follow up will make a ton more money.
So that is the low down on why I feel you should search for physician job opportunities that avoid HMO’s all together. Now, let’s see how the new doctor jobs with the Accountable Care Organizations are going to be!!
Dr. Steve Lin