Poll: Does a patient's insurance status affect your plan?

[IlDestriero]

---

Members do not see this ad.

Note: This is an anonymous poll. However, feel free to comment.

This topic came up in the recent regional thread. We have access to the patient's insurance status on our face sheet that every surgical patient has on their chart. It is also easily accessible in the EMR.
We don't use this info in my academic practice for block/catheter/whatever decisions though I suppose that the surgeons must.
It has not come up in any of my past jobs, except for a derm rotation where it helped guide treatment decisions, Probably in the pain clinic as well behind the scenes? In the regional thread, someone noted that the self pay folks were not getting pumps to go home with, and it made me wonder if this is common or not.
So, do you use a patient's insurance info to determine your plan for anesthesia, post op pain, etc.

 

[Consigliere]

Oh hell yeah it does. Self pay = no nerve catheters.

 

[sleepallday]

This is why all private groups should have a blended unit policy. It takes away the biases in treatment.

 

[IlDestriero]

In two PP jobs I looked at, they had problems in the past with using this info to cherry pick the higher paying cases in eat what you kill practices when making the schedule. One moved to blended units the other removed the insurance data from the scheduling paperwork. One would have to look up every patient individually.
The old "it all works out in the end" is only true if you're playing fair and not getting played.
2 partners were fired from one group for conspiring to cheat the system. While it is sad that they would do that to their partners, it lead to a very transparent and fair system. One many groups could learn from, my own included.

 

[deleted171991]

This is why all private groups should have a blended unit policy. It takes away the biases in treatment.

There should be biases in elective procedures; that's exactly the point. If we don't reward the people who pay us much better (or anything at all), why wouldn't everybody just pay the Medicaid rate (meaning a negative net income)?

There is a reason a lot of civilized countries have multi-tiered systems. One should get what one pays for.

 

[sleepallday]

There should be biases in elective procedures; that's exactly the point. If we don't reward the people who pay us much better (or anything at all), why wouldn't everybody just pay the Medicaid rate (meaning a negative net income)?

There is a reason a lot of civilized countries have multi-tiered systems. One should get what one pays for.

You can't really believe this. I'm sure you haven't given a patient substandard care just because they were on Medicaid.

 

[deleted171991]

I was talking about the hypothetical situation in which I was not an employee, or I had a cost-conscious employer. In that situation, I can see myself limiting my non-emergent care exactly to what is (well) paid for.

 

[bostonblaz]

I look after I have decided what I am going to do for the patient. CPNB is not something I would with hold from the patient just because they won't be paying for it. Sometimes they won't get it because I am not sure if they will use it/ take care of it appropriately, and that decision is made for all comers before I look at their insurance info. I look 100% of the time when I get woken up at 230 am to do a labor epidural or a c/s because those that I do for free are my gift to my fellow man. I am not a religious man but I always remember " what you do upon the least of my brothers you do upon me" and I am thinking if there is an after life... Blaz

 

[dhb]

How can it not affect your decision making? Probably because we as MDs are poorly informed on what is billed to the patient and what he ends up paying. If a patient has financial difficulties why would you impose on him an additional 1000$ or more bill when a valid but cheaper alternative exists?
How do you determine which patient will end up paying not paying or going bankrupt because of medical bills?
For the people that "do what's best for the patient" do you actually ask them if they prefer superior pain control for X$ vs good pain control for x$?

 

[IlDestriero]

I've almost never had a patient turn down a block or epidural for post op pain control when appropriate, but I'm not as block happy as some of my partners. Fortunately, our Medicaid/charity work is not a high percentage of our patients.

 

[deleted162650]

In in terms of regional, it absolutely does. Our billing is done in house so maybe I'm more in touch with what patients are billed than most, but I'm not gonna push hard for a block and stick a patient with an extra few hundred dollar bill if it's not necessary. Now don't get me wrong, if regional is clearly indicated i.e. upper abdominal/thoracic or if the surgeon requests it, I will happily perform the regional. I just may not be as gung ho about pushing for a "grey area" block. And I have offered a "self pay" patient a block and openly told them that it would result in a higher anesthesia fee and left it up to them (in this case I'm more likely to do the block post-op so the pt can make an "educated decision" but I at least talked about it pre-op). We work on a blended unit, but billing more units for block you're never gonna get paid for drags down the common unit value and thus hurts everyone in the group.

 

[psychbender]

Military system, so insurance does not matter. I am a strong proponent of regional (my surgeons are not, except for shoulders), but I argue less for epidurals, since my department has a crappy way of following and managing them post-op.