Current Health Care Environment
Authors: Gene H. Ginsberg
Journal: Annals of Internal Medicine (1999)

Letters19 January 1999Current Health Care EnvironmentGene H. Ginsberg, MDGene H. Ginsberg, MDLehigh Valley Hospital Center; Allentown, PA 18103Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-2-199901190-00023 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Dr. Nolan's analysis of the relationship between family practice and internal medicine in the managed care world (1) can be extended to the next logical conclusion: reimbursement inequity.Managed care plans now tend to classify physicians in both specialties as “primary care providers.” Health maintenance organizations typically reimburse physicians according to a monthly capitation schedule, with or without a copayment. The plans assume that all primary care physicians see large volumes of patients, in short visits, generally in an office setting. However, the plans fail to recognize the intensity and complexity of the internist's approach. In fact, in the eyes of a managed care plan, the speciality of internal medicine does not even exist.The sickest, oldest, most complex patients tend to drift toward the internist. These patients may require more frequent hospitalizations than the general population, and they require lengthy office visits. Many of them are followed up by visiting nurses, and management of a treatment plan for home care takes time and special expertise. On the other hand, many patients who are reasonably healthy prefer to visit an internist because they know that he or she will be more thorough, will take more time, and will be especially astute at establishing diagnoses. I also suspect that an internist will see more “worried well” or psychosomatic patients, who will demand much time and energy.I contend, therefore, that managed care plans reimburse internists and family practitioners equally for unequal services. Clearly, internal medicine has been shortchanged in this new cost-control climate. Our time-honored specialty, so eloquently described by Dr. Nolan, is in grave danger of extinction. Simply stated, don't we deserve to be compensated fairly for excellence?Reference1. Nolan JP. Internal medicine in the current health care environment: a need for reaffirmation. Ann Intern Med. 1998;128:857-62. LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Lehigh Valley Hospital Center; Allentown, PA 18103 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInternal Medicine in the Current Health Care Environment: A Need for Reaffirmation James P. Nolan Current Health Care Environment Albert DiPiero Current Health Care Environment James P. Nolan Current Health Care Environment Edward J. Volpintesta Metrics 19 January 1999Volume 130, Issue 2Page: 164KeywordsHealth careHealth maintenance organizationsHospitalizationsPrimary care physicians Issue Published: 19 January 1999 CopyrightCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...