Featured here, with permission from the San Francisco. The Examiner
01/23/2003
Physician, heal thy cash flow
BY SAMANTHA SPIVAK Physicians say it's increasingly difficult to run a
profitable medical practice. HMO reimbursements don't reflect the market value
of their services. Malpractice premiums are soaring. They're choked with
costly government regulations.
But medical practitioners aren't working to develop
the one sure cure for their fiscal ills: cash patients. There's a potentially
valuable pool of patients (I am one) who qualify for a Medical Savings
Account, a tax-free savings vehicle that's held in combination with a
high-deductible health insurance policy. MSA holders use the account as a fund
to cover basic healthcare expenses. Whatever is left at the end of the year
can be rolled over until retirement.
When doctors see MSA patients, they get paid on the
spot. Patients with MSAs build up a tidy retirement account if they are
judicious about medical spending. Employers who offer MSAs enjoy stable
healthcare premiums, instead of an upward spiral. Insurers are relieved of a
lot of unnecessary claims.
It's an everyone-wins idea in this era of national
panic about health insurance, and doctors who are worried about cash flow.
Why, then, is an MSA patient greeted with blank
stares at the front desk, and mishandled cash after the visit? Why isn't there
a stack of brochures on every reception desk, touting MSAs? Why isn't there a
multimillion dollar commercial campaign that runs during "Friends"
and "Survivor" and "Meet the Press?" Certainly a public
that embraces Individual Retirement Accounts could be sold on the MSA.
Partisan politics is to blame. MSAs are little more
than a footnote arising out of the 1996 health insurance portability
legislation. Congress was already engaged that year in a nasty partisan
struggle about the extent to which Americans should control their own
healthcare. Eventually, the partisans got tired of fighting and went to a
trendy bistro for cocktails. Their staffs wrote up a ridiculous compromise
that gave total healthcare autonomy to a tiny number of people and virtually
no autonomy to everyone else.
Tax-sheltered MSAs were approved, but not for just
anybody who might want one. The number was capped at 750,000, with stringent
eligibility, and the "experiment" was scheduled for a hasty death in
2000. Naturally, no insurance company would spend money to push a product with
a four-year shelf life and a limited number of customers.
Congress has twice rescued the MSA from its sunset.
There is growing political support for MSAs now, inside and outside
Washington. A majority of likely voters think all employers should be able to
offer MSAs, according to a Zogby poll released last week.
Senate Majority Leader Bill Frist, M.D., views the
MSA as part of a package to address the crisis of the uninsured, according to
a spokesperson in his office. But there are still legislators and special
interests who abhor anything that benefits a large number of self-sufficient
people, simply because it isn't a good solution for everyone. They'd prefer
instead to see that everyone has equal access to an ill-managed and
insufficient solution.
This session, Congress will kick the MSA around as
a permanent option with no eligibility restrictions. Objections include the
stupid old concern that ordinary folks might not be prudent managers of our
own affairs. Also, the dire prediction that the young and healthy will flock
to MSAs in such droves that traditional health insurance plans will be left
with nobody but the chronically ill.
It's the medical practitioners who could push this
through with a massive patient education campaign and a show of strength to
the politicians. Help us out here, will ya doc? And make sure the back office
is up to speed.
Comment: letters@examiner.com
Samantha Spivack's column appears Tuesday and
Thursday in The Examiner. Link
to version online at the The Examiner
Examiner columnist
IT
HAPPENS almost every time. The past-due notice arrives. I dig up my receipt,
and call the errant medical billing department to insist that I've already
paid. Their systems are stymied by my cash, which I fork over on the day of
the visit because my health plan requires it. Their staffs can't manage this
unfamiliar commodity called cash, yet doctors are complaining about the
financial hardships of practicing medicine in the age of managed care.