If the woman with severe hip arthritis never sees an orthopedist, she will never know that she qualifies for hip replacement surgery. The woman who is unable to conceive because her fallopian tubes are blocked may not realize that her infertility is treatable. Limit the patient's access to the physician. One doctor sees HMO patients only one afternoon a week. The rest of the week is devoted to cash paying patients.
Several doctors use the strategy of allowing patients to list only one complaint per visit.
That keeps the visits short so that more patients can be seen and allows the physician to collect a cash copayment for each short visit. Since the patients pay the copayment, this does not affect the physician's HMO financial profile. There is also the added benefit that patients with lots of medical problems may get fed up with this arrangement and switch to another PCP who will them be financially penalized by the HMO for their medical expenses. Which brings me to the second main cost containment strategy used by managed care physicians. Simply trying to limit the health care which patients receive is not always effective.