Hsm 546 W2 Dq2 The Effect Of Human Behavior

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HSM 546 W2 DQ2 The Effect of Human Behavior

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<b>Week 2: Patient Management and Relationships - Discussion</b> <b>The Effect of Human Behavior (graded)</b><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td>Explain what actions on the part of the HMO organization would likely cause negative physician behavior. Please provide an example to support your position.</td></tr></tbody></table> <b>Responses</b>Responses are listed below in the following order: response, author and the date and time the response is posted.<table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="11"></td><td width="11"></td><td><b>Response </b></td><td width="160"><b>Author </b></td><td width="116"><b>Date/Time </b></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>The Effect of Human Behavior - Initial Response </b></td><td nowrap="nowrap" width="200">Guertty Lopez</td><td width="185">3/10/2013 10:52:52 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>This week's lecture mentions eight main aspects that can affect physician behavior in an MCO contractual agreement such as the HMO-based organization:1. Environment2. Medical Education3. Autonomy and Control Needs4. Role Conflict5. Understanding the Plan6. Bad Habits7. Poor Understanding of Economics8. Poor Differentiation among Competing PlansOne example where we see physician conflict with the HMO plans is understanding the plan. The HMO has limitations, policies, procedures, and certain requirements that physicians must follow which can be complex. The lecture mentions that "some conflict may result from a physician's lack of understanding about the insurance function of the plan." There are several approaches that the insurance plans use in order to guide the physicians to efficiently utilize the requirements and provisions of the plan while still being able to maintain their patients on the plan. However, this can be difficult as well as a tedious task for older doctors in the field. While it can take their practice in a better direction and can mean a financial increase for them, it can take significant time from their work. Webinars and written communications of instruction may be useful in these cases, where the doctor is able to read and go through them in their time. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: The Effect of Human Behavior - Initial Response </b></td><td nowrap="nowrap" width="200">Elena Hallars</td><td width="185">3/10/2013 11:03:53 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>The 2009 federal mental health act creates many issues that must be considered by plansand payers. Under this law employers can not require higher co-pays or put limits on treatment.This creates the need for case managers, disease management to evaluate the effectivenessof mental health services.MCOs require so much documentation from mental health providers that they have less timeto see clients and provide the therapy they need. Even though case management is part of theUR process it simply burdens the system with too much control over their practices.Source <a href="http://www.urac.org/programs/prog_accred_hum.po.aspx">www.urac.org/programs/prog_accred_hum.po.aspx</a>. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>HMO vs. Negative physician behavior. </b></td><td nowrap="nowrap" width="200">Jose Valderama-Sierra</td><td width="185">3/10/2013 12:12:12 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Many HMO's are influenced by pharmaceutical companies. For example, a company that sells cholesterol pills can loby to congress that pressures HMO and doctors to advise patients to take these pills. But some doctors could have a problem with that, because perhaps some might want to encourage better eating habits or more exercise.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: HMO vs. Negative physician behavior. </b></td><td nowrap="nowrap" width="200">Sandy Williamson</td><td width="185">3/13/2013 2:55:53 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>At times I feel like I could be a Maintenance organization by my self for my mother. I start by going back a few months like in Sept she had surgery where they removed a mass from the rectum and some pulps which was benign 3 days later she fell in her garden and tore a hole in her left arm it was sewed up and back home, next days legs swelled till they left puddles where she walked back to the ER stomach swelled spent 9 days no reason found, out for 3 days back in congestive heart failure swelled again 10 days in this time, aid messed up giving her a standing bath while she brushed her teeth and she fell on top the aid additional 5 days in for hematomas in the same arm with large cut. Gets out Dr. Dr. Dr. Holidays are over. Then she was put on predisone and had a wonderful 5 weeks and now she is down again. But every time we see a Doctors I must go through all of this since one thing leads to another. Oh I forgot some where in there she has broke her left tibia, was it from the fall or was it the predisone, was it caused from osteo what ever.Finally they billed it out as a perforated colon to recoup there money spent, but there was no surgery. Should I report this to the insurance Company? Will they figure it out? They deserve to get paid she was there 19 days.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Read me first:) </b></td><td nowrap="nowrap" width="200">Elena Hallars</td><td width="185">3/10/2013 5:50:39 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Physicians leaving managed care organizationsseems like a negative action that affects thesupply of doctors especially specialists inareas that are not big revenue producers.Looking at this from an HR point of viewthis could take it's toll on employee moraland create more unethical behavior.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/10/2013 6:41:43 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td><p align="center">Thanks Elena...Read you first :) but read all of the others as well. Negative behavior is something that we can't turn away from. It happens because people are human. Nevertheless, our posts thus far have drawn attention to reimbursement and the flexibility to practice medicine. This week we are starting off with those negative assumptions (and some truth) that trigger behavior issues towards managed care. Let's continue with our chat....</p>Explain what actions on the part of the HMO organization would likely cause negative physician behavior. Please provide an example to support your position. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Fredrick Casteel</td><td width="185">3/11/2013 3:36:27 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Marc Rodwin states one action on the part of the HMO organization would likely cause negative physician behavior is that physicians may not perform at his or her customary high level of competence, diligence, or effectiveness. There are several policies that give physicians incentives to withhold services from private institutions and government agencies as response to fee-for-service medical practice. Rodwin states that “rewarding physicians for using resources frugally does not eliminate financial conflicts of interest. It creates new conflicts with different effects.”Rodwin, M.(n.d.) Physicians’ Conflicts of Interest in HMOs and Hospitals, Chapter 1 pp 197 -220. Retrieve on March 11, 2013 from: <a href="http://www.law.suffolk.edu/faculty/addinfo/rodwin/ch9PhysConflofInt-HMOsHospitals.pdf">http://www.law.suffolk.edu/faculty/addinfo/rodwin/ch9PhysConflofInt-HMOsHospitals.pdf</a> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Letitia Armour</td><td width="185">3/11/2013 4:10:11 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Professor Johnson-Warren,Actions on the part of the HMO Organization would likely cause negative physician behavior are:1) Financial stress (not being able to charge the amount of an procedure or what it takes to assist the patients medical needs.2) Conflict of interest in if the Doctor need to refer the patient to a Specialist and HMO says no the Physicians has to accet the doctors they have on based upon the specific list and the primary doctors believe that the patient perhalf may be able to receive the better care in the doctor he prescribed.3) Limitation on how long the patient receive care in a hospital and how quickly or fast HMO press to release the patients.Ofen tmes the Doctor may give up and give less attention to the patients needs and healthcare because his hands is tied. If a doctor feels he cannot receive the financial assistance needed to provide proper care for the patients, then, the doctor will send the patient on through with whatever HMO allows regardless of what specalized reasoning the Doctor may have on this patient. The physicians could be left with the expense of the patients referrals and hospital stays accordingly to an article I reviewed.<a href="http://www.law.suffolk.edu/faculty/addinfo/rodwin/ch9PhysConflofInt-HMOsHospitals.pdf">http://www.law.suffolk.edu/faculty/addinfo/rodwin/ch9PhysConflofInt-HMOsHospitals.pdf</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Sandy Williamson</td><td width="185">3/16/2013 6:17:57 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>The HMO retreat from Medicaid (the U.S. care program for the poor and disabled) has been far more pronounced than that from Medicare (the program for senior citizens). The retreat from Medicare has been mainly confined to rural communities with few patients where clinics and doctors are scarce.Most of the HMO withdrawals from Medicaid have occurred in populous states with large pockets of urban poverty. Half of the 32 million Medicaid recipients are currently in managed health care programs. Hence, at least 16 million people, most of them among the urban poor, are affected by the HMOs cutting loose Medicaid clients.The Medicaid clients who are shed by HMOs have a few options:<ul> <li>They can search for individual doctors willing to treat them for Medicaid fees.</li> <li>They can look (as do the poor in the slums of Bombay) for charity health care.</li> <li>They can go to emergency rooms or to HMOs that accept Medicaid clients.</li></ul><a href="http://www.medicinenet.com/script/main/art.asp?articlekey=6716">http://www.medicinenet.com/script/main/art.asp?articlekey=6716</a>This statement mainly refers to France, but it fits in to what is happening here in the US. We can not afford for any body to be placing cuts on Medicaid or Medicaid we have the baby boomers aging out and not a real strong work force coming in to replace them that is why so many of them are unable to retire at there respective retirement age. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Sheriker Bellard</td><td width="185">3/11/2013 7:39:23 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Many doctors love the work they do caring for patients and their families. But increasingly, practicing physicians are becoming frustrated with the constraints of a medical system that doesn’t always let them do their jobs the way they want to. Often times doctors dont like the hassel of insurance companies telling them they need to do various test in order to make a referral or they basically they feel they are not being able to perform as a normal physician would in certain situation. This would bring on frustrations or not wanting to contract with certain HMO's in order continue to get patients.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Nikki Hetzer</td><td width="185">3/13/2013 10:50:41 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Actions on the part of the HMO organization that would likely cause negative behavior in a physician are the limitations that come with working for a HMO. Limitations including but not limited to not being able to send a patient for every test (that might seem necessary)- in general there is less incentive at a HMO to do additional testing versus PPO where every test brings in more money, not being able to perscribe any medication but only the ones that are given by that particular HMO.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Read me first:) </b></td><td nowrap="nowrap" width="200">Jorge Amador</td><td width="185">3/11/2013 3:26:40 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Elena,I agree with you 100% since in any job if there is too many people leaving the organization it becomes hard to motivate those who are left, it all depends on how the organization can lure more talent to the organization to make up for the shortages. In Managed Care it becomes more alarming since a shortage of physicians means more overwhelmed on the current ones so the care will suffer due to not having the right amount of time needed to truly get to know the patients.I have always said that our system should be focused on Healthcare Promotion instead of just the Healthcare Prevention since if we can teach people how to not get so sick all the time people will not have to seek medical advice as much and we can ease the pressure on our Healthcare System and its utilization.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Effect of human behavior </b></td><td nowrap="nowrap" width="200">Jodie Knox</td><td width="185">3/11/2013 7:20:57 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>The biggest one that jumped out at me was the dual role that doctors are forced to play. Patients expect their physicians to represent their best interests. They want their doctors to prescribe the best medications, treatments, or approaches in order to make them have the best health possible with the least amount of pain, hassle, cost, etc. However, the insurance companies expect the same from the providers. Insurance companies expect doctors to make decisions that are cost effective, that focus on the economics of their healthcare business, refer to specialists within their network, etc. All of these types of decisions reflect the best interest of the insurance companies so as to keep their costs low and utilization of their in-network providers high.Our reading also touches on how the actual workplace of a doctor can be an emotional one because they interact with the patients daily. This makes the representation of both entities even more difficult. I would imagine that this part of the job, the human behavior aspect, could make it quite emotionally stressful.Jodie Knox </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/11/2013 1:07:39 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Jodi, you make a great point here - doctors are expected to play to different best interests. Veterinarians are no different - we play to the best interests of the pet versus the best interests of the owner. For the most part both the owner and I (as the veterinarian) can agree on what is the best interests of the pet. But all too often, there are times when there is a conflict of interest - and the pet loses.My own cat is a perfect example of this conflict of interest. He was a barn kitten when he was hit by a car at six months of age (on New Year's Eve, no less). His then-owner, the farmer, couldn't find him until the next morning, and brought him into the e-clinic immediately. This kitten was my first patient of the day. The farmer told us he knew it was a bad injury that would require expensive care, and he couldn't afford it. He brought the kitten in for the purpose of humane euthanasia.The kitten was in good shape considering that he had an open, compound fracture of the right femur. He was purring away throughout the entire examination. I made the exception to my own personal rule (don't try to rescue everybody - quickest way to bankruptcy!) and provided the farmer with an alternative - he could pay the emergency office call fee, sign the kitten over to us, and leave the kitten's care entirely up to the clinic. The farmer was delighted that the kitten at least had a chance, and signed the cat over to us. We screened him for infectious diseases common in outdoor cats (of which he had none), stabilized him, and then I performed the amputation of the hind leg. He came home with me to recuperate, and my plan was to place him in a good indoor only home. Long story short, he had other ideas, and has lived with me ever since.It is not always that we are in a position to realize the best interests of both the client/owner and the pet. This was a rare exception, and fortunately turned out well for all concerned. Such a resolution is not always possible (especially in those cases where the owner does not want to relinquish ownership of the pet), and in most cases, the owner's best interests win, because after all, it is the owner who is paying the bills. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Elena Hallars</td><td width="185">3/11/2013 2:47:09 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>How about conflict of interest between the physician and insurancecompany? Sometimes the patience best interest is overshadowed byinsurance policies.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/11/2013 9:47:02 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td><b>Modified:</b>3/11/2013 9:47 PM</td></tr><tr><td width="203"></td><td>Great story Julie but Elena does has a good question. When the physician request an procedure and the insurance denies it then this could be emotional for the physician and the patient. It has to be difficult for a physician who knows that a procedure may be the best option but the insurance says otherwise. Could we turn this into a win-win situation?</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Elena Hallars</td><td width="185">3/12/2013 9:43:33 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>First of all the utilization review comittee needs to beconsulted because service and quality of the deliveryof care to the patient is the first priority. Guidelinesand feedback from other physicians in simmiliar situationswill create fairness for all.My next point is influencing physician behavior bycontinueing medical education. I would use more guidelinesto guide patience with defined diseases and symtoms. GainingCompliance with practice protocols can be a challengeand would be better addressed with small groupprograms. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Sheriker Bellard</td><td width="185">3/12/2013 5:53:41 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>I would think that this could be a great gesture on behalf of the physican but working on the insurance side, often times I see patients that are granted surgery or granted admission into a hosptial and they have no insurance. Hospital take a chance on taking the patient due to charity and this is claim at the end of the year due to a loss, but they are by right especially if they are a non profit organization suppose to show that they are not necessarily making money but performing services to a community to a certain extent. However often times the process is so long or they recieve very little money, it often makes me think is it really worth it. I would think as a provider, its possible to do a charitable case every now and then in your career , but at the same time I would not think that as doctor they could continue to earn a living and have a practice that could absolutely afford that type of business.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Tatiania Tabb</td><td width="185">3/12/2013 8:15:38 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>Professor Johnson-Warren, this could be a win-win situation only if the person handling the billing for that physician office could find another code that relates to the procedure code that the doctor is recommending for that patient. Insurance companies are very tricky and I say this because I worked in the healthcare field for 6 years; actually in medical billing. Sometimes insurance companies would not pay for a certain procedure because the bill was not coded right.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="290"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/14/2013 10:30:22 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="313"></td><td>Thanks Tatiania for your reply.Medical coding is a huge factor in the payment war. The errors in medical billing and coding has been extremely high in the past. However, keeping claims uniformed and the movement to electronic medical records will allow less errors in the industry. We are also adding ICD-10 to industry as well. Many other countries has started using ICD 10 many years ago. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="345"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Letitia Armour</td><td width="185">3/15/2013 10:25:19 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="368"></td><td>Professor Johnson-Warren and Class,ICN-10 appears to reduce redundancy and assist caregivers, administrative workers, patients fast access to data entry, less time spent looking for health information and less time to repair the errors made. If a doctor and caregiver can find information by reducing any unnecessary steps, why not? More time to send with your patients and prepare a preventive type of medical care for the patient. Now, because of all of the new healthcare reform people and hospital administration is looking for unique and cost effective ways to eliminate major or unnecessary expenses.<a href="http://it.gehealthcare.com/IP_Google_AdWords_ICD10_paid_search_Awareness_January2013_IP_Google_AdWords_ICD10_paid_search_Awareness_January2013.html?gclid=COfjtcqvgLYCFVGnPAodl1cA6g">http://it.gehealthcare.com/IP_Google_AdWords_ICD10_paid_search_Awareness_January2013_IP_Google_AdWords_ICD10_paid_search_Awareness_January2013.html?gclid=COfjtcqvgLYCFVGnPAodl1cA6g</a> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="345"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Lisa Kieffer</td><td width="185">3/17/2013 6:11:28 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="368"></td><td>Professor are you familiar with the EPIC system? It's our new EMR at where I work. So let's say you are a cancer patient and the doctor has ordered 8 blood tests on you. The doctor HAS to order them not the nurse, he has to enter the ICD-9 codes right when he is ordering them and if he is NOT entering the correct codes, the order doesn't go through. So it falls back on the physician. The EPIC system is great for correct entry of ICD-9 codes. The other problems with EPIC are unreal but that is another discussion. EPIC is very detail orientated and YOU must enter correct items or there is a hard stop and you can't go any further. I come across these problems with our NON-Ochsner physicians or community physicians and I have to enter everything manually which leads to errors. These errors are the hand writing is so bad by the physician that I can't read the test (lab) or the ICD-9 code so I have to take the time out to call the doctors office for clarification. EPIC takes care of all of that. EPIC wants orders also with the community docs. This way I don't have Medical Records demanding orders on patients. No orders no drop bill and that means no payment. Like a domino effect.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="400"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/17/2013 6:50:09 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="423"></td><td>Lisa, we have Meditech as our information system in the hospital I work for. We have all the issues you mentioned in your post and we are trying to get to the point where our system is set up like your Epic system. We are in the beginning phases of implementing computerized physician order entry, CPOE, and it will be nice not to have to deal with illegible orders and missing diagnosis codes. We have that issue in the lab ALL the time and it takes so much time trying to hunt down a physician to figure out exactly what it is he is trying to order and what codes cover it.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="400"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/17/2013 10:41:10 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="423"></td><td>Hello Lisa,I absolutely love EPIC. It's probably one of the best EMR systems for hospitals. Unfortunately, these systems are becoming so remarkable that it's difficult to get students to learn to code with the ICD-9-CM and CPT manuals. Nevertheless, EPIC and other software programs allow medical professionals to enter notes via regular computer type thus helping with errors in medical charts and orders. It also helps with fraud and abuse in healthcare. EMRs is a positive in our system and by the way---over 700 billion dollars has been put in the industry by the government. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="400"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Letitia Armour</td><td width="185">3/17/2013 11:23:29 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="423"></td><td>Lisa,Good explanation. So, EPIC helps to correct entry of ICD-9 codes. It appears that EPIC helps to lower the ratio medicine and medical errors, in regards to the ipatient. I see it must be more to this, do tell. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="290"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Pedro Huertas</td><td width="185">3/16/2013 2:09:22 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="313"></td><td>Tatiana I agree, there are ways to get around the HMO's cost reduction strategies. For example, at work we were receiving a high volume of denials from one of the HMOs and the common denominator was the anesthesia code that we used. We contacted the insurance company several times to inquire about why such an important procedure was denied, but we received conflicted information. Our billing department did exactly what you recommended; they found a similar code and now the claims are getting through without any issues. Fortunately for us, that particular HMO was targeting certain codes while ignoring others that were compatible.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Jodie Knox</td><td width="185">3/13/2013 8:35:04 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>As I understand it, insurance companies look at past situations or precedents (if you will) for making decisions. They look at the statistics of certain conditions, illnesses, and injuries and the treatment given to those situations that were the most useful. I can see how an insurance company would deny a test initially but then the physician would need to prove that the procedure is necessary for improvement of health or saving of life. It is unfortunate that the doctor is not trusted as a medical professional who knows what is appropriate but then there is a balance for cost control and this part is necessary as well since someone has to pay for care.I can see how this is not only frustrating for the patient but for the doctor as well.Jodie </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="290"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Laura Wimberly</td><td width="185">3/16/2013 12:34:57 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="313"></td><td>Jodie, it is so true that insurance companies constantly gauge treatment according to past history. I have a friend which was receiving constant therapy service for the past year under his insurance company. Upon the start of service, he spoke with the insurance company to make sure that he was covered and what the guidelines for service were. Within the last month he received a letter stating that the doctor was no longer part of the network; therefore he reached out to his doctor and she was still a certified phsysician and recertified with all appropriate paperwork on file. After various conversations, basically the insurance company stated that the patient did not recertify under the physician therefore they could not continue service under this physician unless he would pick up the bill. Somehow they decided that there was a limitation of services that he could receive and ; and addressed the issue a different way; this only affected patients under this certain insurance company and receiving service for an extended time frame..</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/15/2013 8:33:07 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>Elena sorry for not responding sooner.I am referring to a third party payer system in the veterinary field - the owner plays the role of the insurance company in human medicine. The biggest difference between human and veterinary medicine is that the pet's owner has near total autonomy over the pet's health care - we can not force a treatment on the pet without taking on serious financial risk. When there is such a narrow profit margin between operating costs and total revenue (as is typical in many clinics), we do what we can to minimize that risk. So for that reason we face the same issues that physicians often face. Fortunately in most cases there is more than one way to skin a cat (excuse the pun), so most of the time we can figure out something that benefits all of us.And yes, Professor, it can be very emotional for the physician to watch the patient suffer needlessly because the payer refuses the essential treatment. One big difference is that veterinarians can always offer the option of humane euthanasia - at least the pet no longer suffers. Physicians really do not have that option in this country. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Lisa Kieffer</td><td width="185">3/16/2013 5:22:40 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>I will tell of a true story of a good friend of mine and her struggle with her insurance and much needed heart surgery. She has a condition called Tetralogy of Fallot and has kept her condition under control for most of her life. She threw a clot, had a mini stroke and then found out she had a hole in her heart that she was told should be closed by now at her age which is 48.She ended up undergoing through a great deal of tests and found out she did not have a pulmonary value and her heart was enlarged. She needs surgery and NO one in the state of Louisiana does this surgery. Baylor in Houston and the Mayo clinic in Minnesota does. She has insurance through her employer and at first they tell her she can have it, paid for in network.She has the surgery and then the bills come in. After the over $100,000 bills start coming in the insurance company doesn't want to pay in-network. She had to fight with letters from all of her doctors stating that the surgery could not be done locally and she needed to go out of the state for this MUCH needed surgery. After it's all said and done she is left with around $15,000 in bills from this surgery and that originally she was told shouldn't be no more than $5000 out of her pocket. What is wrong with this picture?</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="290"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Nikki Hetzer</td><td width="185">3/17/2013 8:12:49 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="313"></td><td>That is horrible. I heard that too many times. It almost appears also that insurance companies will fight claims first and many people give up and pay. We had a out of country emergency once and checked with our insurance company before we left if something happened if we would be covered. They said yes in an emergency necessary procedures will be covered. Something did happen and when we sent in the paper work to get reimbursed they denied it of course. After sending in the names of people we talked to before leaving the country as well as the print out of their terms (of what would be covered) we finally got reimbursed. I think if they always do that or even just quite a bit they probably rum into people who will just cover the costs themselves because they either don't have the nerve, time or maybe do have the money to cover it. It's sad.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Keniyotha Williams</td><td width="185">3/12/2013 8:50:32 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>Elena, I would agree. I would like to add that there is a conflict with physicians in general. When a doctor refers a patient to laboratory, x-ray, surgical or diagnostic treatment in which there is a financial gain to the doctor, conflict arises. Many of the facilities doctors send patients are partially owned by the physicians. For example, I was running (exercising)and trip over something. When I fell, I caught myself(all the weight was on my left arm), but my arm felt funny. After 2 days, I finally went to an Urgent Care Facility. They took x-rays and recommended several bone specialists. When I went to the specialists, I informed them that I had x-rays and they could call the facility to send the x-rays over. They didn't. They took more x-rays of the same thing. That was a waste in money for the insurance companies. The information was readily available, but they chose to use their own equipment. The insurance company was charged twice for the same thing.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Jodie Knox</td><td width="185">3/12/2013 7:17:54 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Hi Julie,Thanks for sharing your story; it is very touching. Veterinarian care is a form of healthcare that we have not included in our discussions. It is very common for people with pets to be uninsured. In fact, I'm not sure how long insurance for pets has been around but it is really smart. I would argue that anyone who can afford a pet (food, shots, check-ups, dog watcher, etc.) can afford at least the basic level of insurance but most pet owners are unaware it exists or just haven't given much thought to it. Of course farm owners being a different kind of pet owner for dogs and cats (they get to be more in their wild state!).I got my dog from an animal rescue. When I brought him for his first vet visit, the vet told me that he had a severe luxating patella and that it was almost certain that it would need operation later in life. He told me that, if it was alright with me, he was not going to put that in his medical record. He told me to go and purchase insurance so that when/if it happened I would be covered but that if it was deemed a pre-existing condition by him notating it on that visit, that he would not be coverable for that surgery down the road.I know it may sound like the vet played the system and maybe shouldn't have done that. That being said, he must have seen the case happen too many times where a good dog gets put down because the owner can't afford the crazy expensive surgery when the patellas do go out and the dog goes 'down' for it. Personally, I am thankful for his judgement call. I purchased the insurance (the golden plan!) and have been paying for it for the last four years. Hopefully I will never have to use it but I am glad to have thought about my dog's healthcare from an insurance standpoint. It may save me tons of money and heartache in the end.Jodie </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/13/2013 7:48:05 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>This is a good story Julie and a great outcome for your cat. I wonder how many times this happens with animals that dont have owners and they just end up suffering. I believe this happens with people as well because I have heard so many people say they are not going to the doctor because they cant afford to and they dont do anything about their condition until they are forced to go to the emergency room because their health has gotten so bad. This has to provide some conflict with many family practice doctors that have patients that really cant afford the appropriate treatment so they have to either treat the patient and suffer a financial loss or be forced to turn the patient away, sending them to an urgent care or over crowded emergency room.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/15/2013 8:39:22 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>Thanks David. This happens even when animals do have owners. As Jodie said in an earlier post, most people aren't aware of pet insurance. And yes, it doesn't cover genetic/congenital conditions (luxating patellas are considered genetic because it is due to deformed bones resulting from past breeding decisions). However there are riders available that will cover things like preventative care, dental care, and even cancer (if obtained while the pet is still young).Many people don't seek medical care for much the same reasons that many pets don't get veterinary care - they can't afford it. I can't begin to tell you how many times I saw pets at the emergency clinic that had no regular vet, how many geriatric pets (older than 8 years of age) who hadn't seen their vets since they were pups and kits, and were in horrible shape because their health was so neglected. We see the same in people - there are many who won't go to the doctor for routine care. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Keniyotha Williams</td><td width="185">3/11/2013 3:22:09 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Jodie, I agree with the double role of the physician. Patients do expect physicians to prescribe and diagnose in their best interest, but so many physicians receives bonuses from pharmaceutical companies. Because of the incentives to promote certain medications from companies, doctors are swayed away from having their patients best interests. For example, instead of recommending a life style change to lower blood pressure, many doctors prescribe certain medications. Example, I was diagnose with pre-hypertension. Instead of giving me advice on how to lower my blood pressure, my doctor wanted me to take pills right away. I tried to explain to her that the spike in blood pressure must be caused by something other than foods. My eating habits had not changed, but I was recently in a car accident and the stress of lawyers and etc. was really getting to me. Up until then, my blood pressure was consistent and considered normal. I refused, but when I couldn't get a handle on it, I gave in. I also went to see a heart specialist who wanted to prescribe me a different type of drug to reduce my blood pressure. Well, I was surprised when I received something in the mail stating that I was not supposed to be trying a stage 3 medication until it was noted that the stage 1 medication didn't work. Then I was suppose to try a stage 2 medication. I was under the impression that I was given samples. I didn't know that the insurance company was being charged for the samples. How was I supposed to know the list of stage 1 medications? Needless to say, I switched PCP and I cancelled the appointment from the cardiologist. I have changed my eating habits drastically, increased my intensity of the workouts, drink a concoction of water and ginger, and take two teaspoons of apple cider vinegar every morning. With all of that, my blood pressure is 105/74, which is considered to be great. It has gotten to the point that I would rather research my potential problem and try different alternatives before I go see a doctor because of the conflicts physician have.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Jodie Knox</td><td width="185">3/13/2013 8:37:14 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Keniyotha,I am sorry to hear about your experience and thank you for sharing. That is truly unfortunate that your doctor's interests were swayed by the marketing of a certain drug verses the holistic view of their patient and what may be causing your problem as well as a non-drug, or lower dosage, approach first.Jodie </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/15/2013 9:14:26 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>It's sad but true that many prescriptions are written due to pressure from the drug companies. And I don't see the issue going away anytime soon.<a href="http://www.economist.com/news/business/21572784-new-efforts-reveal-ties-between-doctors-and-drug-firms-let-sunshine" target="_new">Pharma Marketing and Doctors</a>I've seen much the same thing in the veterinary field. Sales reps offer incentives such as discounts on bulk orders. Then we are stuck trying to use up the product before it expires. We don't get refunds on expired drugs - it's not the company's fault we couldn't use them up fast enough. It is less of a problem in veterinary medicine though, because most of us are stubborn folks who don't like big business telling us how to practice our medicine - especially the practice owners. As for us associates, we just don't care about this stuff - if it doesn't work we won't use it. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Satchit Ladwa</td><td width="185">3/16/2013 9:51:00 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>In a study conducted in 2006 by Health Services Research, changes in lagged relative HMO penetration are negatively associated with changes in specialist physicians per 100,000 population. "However, this effect of HMO penetration is attenuated and at times reversed in areas where the magnitude of the difference in relative economic conditions is sufficiently large." The study did not find any statistically significant effects for primary care physicians. Consistent with prior studies, the study found find that changes in physician supply are associated with changes in relative HMO penetration. Relative economic conditions are an important moderator of the effect of changes in relative HMO penetration on physician migration.<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702524/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702524/</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Effect of human behavior </b></td><td nowrap="nowrap" width="200">Nikki Hetzer</td><td width="185">3/16/2013 11:40:01 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Jodie, I totally agree that one of the crucial factors is the dual role the doctors are forced to play- that might have a negative effect.To represent both sides might not be possible at all.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>HMO Organizations and negative behavior </b></td><td nowrap="nowrap" width="200">Jorge Amador</td><td width="185">3/11/2013 3:22:06 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>I believe some of the actions on the part of the HMO organization that would likely cause negative physician behavior would be focusing on too much of the "pure volume" when it comes to how many patients are seen since the patient will not receive the right care due to the fact that physicians will want to treat more people in order to make more income which can have a negative effect on the HMO and the physicians over time. Some of these examples can be found with Scams that have come on Television like malpractice where physicians find ways to treat more patients and offer less popular methods to save a human being. One such example of possible focus on volume would be from a research paper I did with the Japanese Healthcare System. Where doctors are focusing more on being physicians since they can get reimbursed more then specialists since they are paid by volume so there are less specialists in Japan then just Primary Care Physicians.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: HMO Organizations and negative behavior </b></td><td nowrap="nowrap" width="200">Keniyotha Williams</td><td width="185">3/15/2013 12:36:48 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Jorge, I see your point. I didn't know that Japan had more physicians than specialists and the pay was based on your field of expertise. It all makes sense to me. I never understood why doctors made appointments at certain times, but I would be in the waiting room for hours. When I would finally get to see the specialists, they would zip through the appointment. For example, I use to have a hematologist because I had low iron and we were trying to determine the cause. Well, after taking tests that came back normal, we concluded that I was a person that I was normal and healthy and my body was able to function through the changes.. Even after we concluded that her services were no longer needed, she kept scheduling me and taking unnecessary samples of my blood to run the same tests that told her that maybe my body was going through a change but everything is now normal (what SHE stated before). It was like she didn't document what we had talked about. Well, I went two more times. The last scheduled time, I cancelled and never rescheduled since she already stated that I was fine. She was a specialist and I guess she was trying to book me a few more times for guaranteed money.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>The Effect of Human Behavior </b></td><td nowrap="nowrap" width="200">Tatiania Tabb</td><td width="185">3/11/2013 4:32:25 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>I believe that the actions that HMO organizations would likely cause negative physician behavior would be cost. I think the cost of the procedures that physicians get paid for when it comes HMO plans could be low in price so that physicians feel the need to charge extra billing charges to patient insurance plans. For example, I worked for a physician who had allegations of over billing patients insurance plans for procedures that were never done. I think physicians get caught up in falsely billing insurance companies because they feel that they do not get paid enough for procedures they render to patients from there insurance plans.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>The Effect of Human Behavior </b></td><td nowrap="nowrap" width="200">Latia Phelps</td><td width="185">3/11/2013 6:36:52 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>What actions that may negatively affect physician’s behavior would include a new system and technology changes and more rules and policy changes. The physician will take this into account when thinking about opening up a practice due to different laws in various states. According to an article by Rand Corporation "Health Maintenance Organizations and the Changing Physician Workforce"; The researchers found that the growth of managed care in the United States, particularly the growth of health maintenance organizations (HMOs), has had a profound effect on the practice location choices of both generalists and specialists. In addition, the growth of HMOs appears to be influencing physicians' retirement decisions, further contributing to a geographical redistribution of physicians throughout the nation.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/11/2013 9:50:59 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td><p align="center">Describe and discuss today's healthcare consumer, and briefly comment on how these traits affect patients’ interactions with the healthcare system.</p> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Jose Valderama-Sierra</td><td width="185">3/12/2013 10:35:05 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>There are several things on health care consumers mind, mainly how will Obama Care change how we see health insurance and will it really be an adequate provider for Americans. Most concerns is that services will be thinned out and we wont be getting same or adequate health services, after the universal health care takes into affect.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Teresa O'Brien</td><td width="185">3/13/2013 10:13:33 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td><b>Modified:</b>3/13/2013 10:18 PM</td></tr><tr><td width="148"></td><td>According to Deloitte’s 2012 Survey of U.S. Health Care Consumers has identified six distinct consumer segments that navigate the healthcare system in very different ways. These segments are listed below, along with their demographic %. As I read through these, I think I probably know at least one example of each. (I think I am probably Online & Onboard or sometimes Casual & Cautious)<b>Online & Onboard</b> - Online learner; happy with care but interested in alternatives & technologies (17%)<b>Casual & Cautious</b> - Not engaged; no current need; cost-conscious (34%)<b>Shop & Save</b> - Active; seeks options and switches for value; saves for future health costs (4%)<b>Content & Compliant</b> - Happy with physician, hospital and healthplan; trusting and follows care plans (22%)<b>Sick & Savv</b>y - Consumes considerable health care services & products; partners w/physician to make treatment decisions (14%)<b>Out & About</b> - Independent; prefers alternatives; wants to customize services (9%)This diverse group of individuals needs to be handled differently because:<ul> <li>Prevention, preparation, & sense of accountability differ</li> <li>Differentiated through online & innovative technology use</li></ul>About the survey: Each year since 2008, the Deloitte Center for Health Solutions has surveyed a representative sample of up to 4,000 U.S. adults about their interest in and ability to operate in a consumer health care market. Visit <span style="text-decoration: underline;"><a href="http://www.deloitte.com/us/2012consumerism">www.deloitte.com/us/2012consumerism</a></span> to read the entire survey and the survey methodology. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Jorge Amador</td><td width="185">3/12/2013 11:01:51 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Professor,Today's healthcare consumers want to get top notch healthcare results and treatment, one thing that is a concern is with the potential shortage of physicians and also the increase in patients with the new Healthcare Reforms it could happen to what happened to me last year:Last November I was sick and thought it was simply a cold that would go away, went into get care and got medication for a "Sinus Infection".Did not get better so had to keep calling out of work and went in again to the same walk in clinic and was diagnosed under "Positional Vertigo"Was given medication that made me dizzy so went in to get care from my PCP.He diagnosed me with some type of Sinus Infection too and got a CT Scan done then went to a Specialist.The Ear, Nose and Throat Specialist got what I had and it ended up being a Tonsillitis case and got the right medication for it to finally get better. That was after he examined me with a camera thru my nose.So what it seems is happening is that there are so many patients and so little time put onto patients and getting to know them to get the right medication and prognosis done so that way the utilization goes down as more and more times we get sent in to get checked.Patient Satisfaction will be and keep on being low due to this unless things change.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/12/2013 11:33:52 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Thanks Jorge for your post.Indeed time is a major issue with patients and doctors. Take a look at the Mayo Clinic video that I have in the first thread. One point that they make is that physicians have to take time with patients to listen to their concerns. By listening they are able to properly diagnose the first time around and order test related to the chief complaints by the patient. They state that a physician that continues to order tests shows a sign of inexperience. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Guertty Lopez</td><td width="185">3/13/2013 10:56:31 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>Yes, the video mentioned how "lots of tests does not equal better quality of care." Sometimes, so many tests are conducted on a patient, that he or she feels too weak just to go back to get their continued care, right! Or they may not return for another quarter until they have the money to afford the costs again, as well. Meanwhile, they're just not getting the right care at the appropriate time, they may get more sick, and therefore, the providers makes more money because eventually they have to be going back to them. "Quality means getting the right treatment for the right condition at the right time" (Guram & O'Shea, 2009).Guram, Gurjeet and O'Shea, John S. (April 24, 2009). "<i>How Washington Pushes Americans into Low-Quality Health Care,"</i><a href="http://www.heritage.org/research/reports/2009/04/how-washington-pushes-americans-into-low-quality-health-care">http://www.heritage.org/research/reports/2009/04/how-washington-pushes-americans-into-low-quality-health-care</a> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/15/2013 9:19:48 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>In vet school I was taught that the History (listening to the client describe the presenting complaint) was the most important part of the entire process, closely followed by a thorough physical examination. Next was the client education portion (usually the last part of the medical record for the patient encounter), where we discussed diagnosis, treatment and prognosis with the owner. Treatment was the least important part of the process in that it is dictated by the history, physical examination, diagnostics and the owner's compliance.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Nikki Hetzer</td><td width="185">3/17/2013 8:19:00 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>I think this is true- however time will always be an issue- after all each hospital- doctor's office, etc. is a business. I like that the Mayo clinic emphasizes listening to the patient in order to properly diagnose and I like that they feel like ordering too many tests is a sign of inexperience.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Fredrick Casteel</td><td width="185">3/12/2013 2:36:43 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Today healthcare consumers are using a different method of treatment for common diseases. With so many different methods of herbal medicine listed on the Internet, herbal vitamins, etc. it has replaced the traditional method of seeking physician services for many of these treatment. No every medical attention can be replaced by herbal products, but when consumers are faced with a high expensive medical bill for certain services, they are now drawn to getting an supplement insurance coverage that will come in to help the main insurance pay for the service billed.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/13/2013 8:28:48 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>I agree. Today's healthcare is extremely advanced because technology allows us to diagnose patients quicker and with less invasive procedures. We can accomplish more because we can see processes taking place at a molecular level and tests that used to take days now only take hours. Robotics andtele-medicine are playing more of a role in patient care today. Information technology allows providers to recall patient information quickly because of the digital age we are living in. Information systems are being created so that they interface with systems that have different platforms.This is all great, but it comes with a high price tag that is passed on to insurance companies, which pass the cost on to consumers. This is requiring healthcare consumers to be extremely price conscious and affordable healthcare can no longer be taking for granted. Even those with good jobs that have good benefit packages often have to search for supplemental insurance because if they suffer a serious health injury or is considered high risk, some of their health needs may not be covered by the primary insurance. We have to be concerned about co-pays and possible out of network specialist costs and the ability to make ends meet when we have to pay these additional expenses.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Peru Tuika-Soske</td><td width="185">3/12/2013 4:11:07 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>I have to agree with my classmates on this issue and how we are too many patients and not too much help (physicians, nurses, etc). We are being either rushed in and out of the physicians office with little to no good help, or waiting around to be seen because of the high level of traffic in a doctor's office or ER. Today's healthcare consumer are wondering if we will get the right care that we need and expect to get when we go in to get checked. For the amount of money we pay monthly for this service, we should be getting great care service along with our healthcare system being easily accessible to today's healthcare consumer.This is where utilization management care comes into play, as we talked about in our first discussion question. This is where it will benefit the patient as well as the health care provider by helping patients receive the most appropriate care. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Pedro Huertas</td><td width="185">3/12/2013 9:18:01 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Today’s health care consumer has many more options than before and has forced its way to become the focus of the industry. The health care industry experienced a transformation that introduced the patient centered care model as a viable option to meet the demands of today’s patients needs. Patients are more aware of the importance of preventive services to maintain health and the industry has responded to provide the necessary services. In addition, access to care has improved as community hospitals are an intricate part of today’s expanded health care system.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Julie Hicks</td><td width="185">3/12/2013 11:57:19 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Today's consumer is sometimes given all information in advanced so that they may be able to make an informed decision, in a perfect world. Patient goes to an appointment about a problem the the doctor may or may not runs some test. Now, the patient is told to go to the lab and get some blood work done basis of the diagnosis and treatment the doctor is planning . The patient still isn't told the cost of the visit or the laboratory tests that they are being sent to do. Most people will assume that the visit and la tests are covered in their health plan. Most health plans don't cover everything and the patient doesn't know until a bill come s in the mail. Most patients are got off guard this way with their health insurance plan.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Sherita Swinton</td><td width="185">3/13/2013 5:33:16 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Today’s consumer is interested in obtaining more information. There is a need for increased accessibility regarding healthcare information as they can make well informed decisions about the care that they need and desire. Consumers want to be able to communicate with their providers.SheritaKongstvedt, P. (2007). Essentials of Managed Health Care (5th ed). Jones & Bartlett Publishers.Retrieved from http://devry.vitalsource.com/books/9780763797928/S7/0 </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Letitia Armour</td><td width="185">3/13/2013 8:30:21 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td><b>Modified:</b>3/13/2013 8:36 PM</td></tr><tr><td width="93"></td><td>Professor Johnson-Warren,I reviewed an article called HSR Health Services Research, discusses how consumers are growing in numbers and having a large impact on the ultimate cost and outcomes of health service use. I believe that the role of the consumers is changing the healthcare delivery system. Patients are affected by the changing healthcare reform and choices patients have to decide. Also, how the consumers affects in the healthcare system. Consumers must take charge of their healthcare and how much it has in influencing on the outcomes of the patients in the costs and medical choices. Patients seek out the right physicians and healthcare services by reviewing different resources to find the right service or care. Healthcare is changing so much that it is very important to make sure one research and find the doctor and healthcare providers that take care of their needs and cost efficient. Now, because of the changes that is taking place in the healthcare makes it more and more important for patients to choose wisely what care providers and physicians they use.<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360911/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360911/</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Nikki Hetzer</td><td width="185">3/16/2013 11:53:27 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>I think today's health care consumer wants top notch care. Today’s health care consumer is more involved and knows what they want- today’s consumer is not passive anymore as they once were. They are taking more ownership for their care. Deloitte’s 2012 Survey of U.S Health Care Consumers on this site: <a href="http://healthdecide.orcahealth.com/2013/02/20/todays-healthcare-consumer/#.UUVZlFfEKSo">http://healthdecide.orcahealth.com/2013/02/20/todays-healthcare-consumer/#.UUVZlFfEKSo</a> shows six distinct consumer segments that navigate the system.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Today's Healthare Consumer </b></td><td nowrap="nowrap" width="200">Sheriker Bellard</td><td width="185">3/17/2013 1:37:47 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Todays healthcare consumer is really concerned about how the cost of medical care will take care of their healthcare needs of the future. Political concerns are raising many eyebrows in reference to premium prices and will we all be able to afford medical care that will be required regardless if we can afford it or not. At the same time healthcare consumers are worried about the shortage of healthcare staff members will definitely cause poor quality care that we will not have a choice to pay for due to new laws that are being passed. Many patients now are not seeing doctors as they should due to not having access due to no medical insurance, however patient will have an opportunity to seek care due to the new ObamaCare Program but many often wonder at what cost?</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Antonio Walker</td><td width="185">3/12/2013 2:23:47 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Mrs. Warren,HMOs control utilization and contain costs, which may result in lesser demand for physicians' services. This can create a pessimistic environment and definitely affect the physician behavior. Physicians may become more reluctant to locate in market areas with high HMO presence. Physicians fear HMO’s sharing financial risk with physicians and a lost of self-sufficiency. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/12/2013 11:40:45 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Nice point made Antonio.Let turn it around to look at a physician in a hospital based HMO. There are unique challenges a provider or hospital-sponsored HMO has in managing utilization. This is a common problem for the few hospital-sponsored HMOs still out there. The basic problem is that the very same physicians that a hospital embraces for FFS patients are the ones that can create significant financial problems when the system is accepting risk: physicians that utilize a lot of services. Dealing with them directly, or even not including them in the HMO network risks alienating them, creating problems when the physician switches to another hospital.It is difficult to keep everyone happy in the HMO camp but many factors can establish good or bad physician behavior towards a managed care plan. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Jorge Amador</td><td width="185">3/13/2013 10:22:42 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Professor,I do believe that unless something changes much like the Mayo Clinic Video states physicians I believe due to the system they are in have forgotten the true reason they became a doctor and that is and should be to help others!HMO camps are indeed tricky to keep happy but I believe if things were to improve there has to be a major change in the behavior of physicians whether its in an HMO or other systems. The way Physicians are compensated makes them less worried about the care they give and more about how many patients they take in which should not be the focus of a physician.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Fredrick Casteel</td><td width="185">3/13/2013 2:39:07 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>I agree with you Jorge, you have made a good point. The behavior of the physician has to change no matter what. In this issue from AMCP Organization, in October 1998 says “In October 1998, a large medical service organization representing an independent practice association of physicians in North Texas terminated its risk-contract with one of the largest HMOs in the country for not providing claims data in a timely and complete manner, making it impossible for the medical service organization to manage financial risk”. These are the issues physicians are having and Mayo Clinic reduces this problem by offering salaries to these individuals. This changes their mind thinking towards the patient’s health and not seeing the patient as a dollar sign.<a href="http://www.amcp.org/data/jmcp/EditorialSubjects_572-575.pdf">http://www.amcp.org/data/jmcp/EditorialSubjects_572-575.pdf</a> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Peru Tuika-Soske</td><td width="185">3/13/2013 5:49:06 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Jorge and Fredrick hit it right on point with their comments. That is the same direction I was also going with this comment. I think no matter where you work and under what plan, if you are in the medical field, I would think that you got into that field to help people, not for the money..Mayo clinic provides such a great example of what being a physician is all about. It should be all about helping and making the patients live easier, with less tests and just finding other ways to help them with the main concern being to help, not how much they can make for each patient they see. I feel that if all physicians can get on the same page with how they operate, things can be fixed towards their behaviors to managed care plans.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: HMO Impact on Physician Behavior </b></td><td nowrap="nowrap" width="200">Antonio Walker</td><td width="185">3/13/2013 11:45:26 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Mrs. Warren,Fee-for-service unbundles services and payments are made for only service rendered. The problem comes in when the service given is not monitored for suitability. It starts to become a morality issue. What is the real reason for providing healthcare? We really need to reform the healthcare culture. It is about patient care but somehow the culture has evolved into this money making pit. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>negative physician behavior </b></td><td nowrap="nowrap" width="200">Stephanie Lynch</td><td width="185">3/12/2013 6:27:41 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>this week i am in a meeting to try and help streamline our financial aid application process. tomorrow we are going to discuss our "pre-qualify" patients, patients who need a procedure done and are inquiring if they are eligible for assistance before hand. Currently we are asking for a letter from the physician stating what the procedure is, how the physician is helping the patient and if this procedure is emergent or not.I can see this possibly leading to upset physicians if we change the process too much and make it more difficult for them or ask more from them. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: negative physician behavior </b></td><td nowrap="nowrap" width="200">Sandy Williamson</td><td width="185">3/15/2013 6:32:13 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Try this out.We visited a doctor about mom's knee that is hurting so it is x-rayed and shows nothing so he orders her a MRI to look for a stress crack, but we had to wait to use his MRI Machine 25 miles away so she walks on this leg for another6 days. So we get the MRI on Wed now we must wait 5 more days for the results in the mean time she is still walking on it so Monday rolls around now she is sick with something else and now she is in the hospital, I called and canceled her appointment and asked for the Doctor to call me with the results, so his nurse called said yes there is a crack and a tear in the plateau of the left tibia call to make another appointment when you can.(we are sitting in a hospital already)so I called Tuesday went in on Thursday (yesterday) He says yes it's broke, presses on it so hard it may of re-broke (I thought mom was going to smack him) says well we are going to immobilize it for five weeks see you then nothing about a tear. sends in a brace salesperson to fit her with a 3 foot splint. So now she is a 85 year old lady hopping around on her right leg in order to move around. Well I got to thinking if it was ok to walk on it until we seen him 10 days later the only thing this splint was going to do for her was to break her right hip from hopping so I called her insurance company and spoke with a nurse who agreed that this was going to go wrong so I ditched the splint and called a different doctors for a second opinion. Was I correct in what I did? What would any of you of done.This is a Doctor who is after the almighty dollar, he doesn't care about her leg, but I am sure he is waiting to do surgery on her hip when it breaks.Doctors need to remember the oath they took and that medicine is all about the people. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: negative physician behavior </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/15/2013 9:29:42 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Sandy, that is just the thing that irritates me about so many MDs.After spending so many years developing treatment plans that a) result in a high chance of a positive outcome, b) is easy for the owner to comply with, and c) is easy for the pet to live with, I just want to smack doctors who make recommendations without taking such things into consideration. It tells me they are looking at the disease but not the patient. Arrgh!I can't say that you did the right thing, Sandy, but I agree that I would have done the same thing - asked for a second opinion. I'm not sure about going to the insurance company, though. They have a vested interest in minimizing financial risk and I can't be certain that they have the patient's best interests at heart, especially since the nurse never really saw the patient in person. Sorry, but nothing replaces a face-to-face encounter between doctor and patient.As a veterinarian I've tried to spend time "getting to know" my patients. I consider it part of my physical exam to watch the way they move and interact with their environments, to get on the floor with them and encourage them to become acquainted so I have an idea of their personalities and how they react to me, before I even progress with the "real" physical exam. I think that's the reason why they called me the "cat doctor" over at the emergency clinic, because I could accomplish things with cats that the others couldn't. You simply can't rush things with cats, nor can you compromise their sense of dignity or make them feel cornered. Ever. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Physician behavior </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/12/2013 8:57:56 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>One issue that can cause a huge conflict with physicians when work with MCOs is the feeling of having to ration health care. The lecture states ''Physicians are often viewed as patients’ advocates, but they are faced with the challenge of rationing care. Such situations can cause the physician to feel conflicted between his or her duties to a patient and his or her duties to the managed-care plan.'' This may come into play when a physician has to recommend a cheaper and less effective treatment plan for a patient because of the patient's insurance coverage.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Physician behavior </b></td><td nowrap="nowrap" width="200">Brenda Grant</td><td width="185">3/13/2013 7:33:59 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>This could be very dangerous for the patient as the physician may not offer a treatment which is effective enough to treat his or her condition. In certain conditions, certain symptoms can mask other conditions. If a physician feels conflicted in time and offers the wrong treatment plan this may prove detrimental for the patient.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Physician behavior </b></td><td nowrap="nowrap" width="200">Sherita Swinton</td><td width="185">3/15/2013 3:03:02 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>David,Great post! I feel the same way as you do about physicians and managed care. There is a bit of role conflict when you are expected advocate for your patients. But at the same time you much limit the amount of care that is rendered to the patient. I also feel that the constantly changing environment that physicians work in backs them into a corner. Healthcare costs are on the rise, technological changes and advancements, not to mention, change in the practice of healthcare can be a bit challenging for physicians working under the constraints of managed care.SheritaKongstvedt, P. (2007). Essentials of Managed Health Care (5th ed). Jones & Bartlett Publishers. Retrieved from http://devry.vitalsource.com/books/9780763797928<b> </b> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>HMO and Physician behavior </b></td><td nowrap="nowrap" width="200">Lisa Kieffer</td><td width="185">3/13/2013 2:02:45 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>The practice of using generalists as "gatekeepers" may restrict patient access to specialists, causing a decrease of specialists which are very much needed in all fields of medicine. The practice of capitation and sharing the financial risks with physicians may reduce diagnostic tests and other procedures patients may need as well as referrals to specialists. If the cost exceeds the patient's cap then it is assumed by the primary care providers. By monitoring practice behaviors the use of clinical practice guidelines to define acceptable standards of care, and utilization review to control excessive use of procedures and services may also decrease the use of those procedures and services as well as the specialists who perform them. Among established physicians, the growth of managed care has a negative effect on professional autonomy and job satisfaction appears to be decreasing.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>HMO Conflict </b></td><td nowrap="nowrap" width="200">Brenda Grant</td><td width="185">3/13/2013 7:31:39 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Physicians may show negative behavior when there is not a clear understanding of the regulations and standards of the HMO policies and procedures. As the lectures clearly states, "some conflict may result from a physician's lack of understanding about the insurance function of the plan." MIsunderstanding the policies and procedures provided in and HMO may cause a physician to be ineffective and inefficient. Physicians may become very frustrated and have a negative outlook on the HMO and reflect negative behaviors as a result.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: HMO Conflict </b></td><td nowrap="nowrap" width="200">Sherita Swinton</td><td width="185">3/17/2013 10:35:47 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Brenda,Great post! I agree with you. A lack of understanding and frustrations by the physicians can also lead to a lack of understanding by the patients. As you mentioned the physician's ineffectiveness can affect the patients as well. Their lack of understanding can lead to extra, unnecessary fees for the patients.Sherita </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/14/2013 10:25:05 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td><p align="center"><b>In the News: </b>Let's incorporate a forum where students are expected to read peer review article on the backlash or negative opinions of HMOs from one of the library resources, post the link to the article, and discuss its importance either to how to change negative opinions or healthcare in general.</p> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Peru Tuika-Soske</td><td width="185">3/15/2013 5:01:38 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>I found this article interesting, especially the percentage of people who felt that HMO only cares about their image and making money. This has been a concern that has been made quite often about HMO. One of the main complaints about HMO is being able to see a specialist. To me, as a patient, I believe that you have a right to seek out any type of medical care you want and be able to see whom ever you feel necessary. This is our life on the line and if your medical healthcare insurance is making it difficult for you to do that, I think you should either change your plan or keep complaining until something is done about it. A patients health should be the number one priority to a physician, not how much they make and that is the bottom line.<a href="http://articles.cnn.com/1997-11-05/health/9711_05_managed.care_1_hmos-susan-pisano-drew-altman?_s=PM:HEALTH">http://articles.cnn.com/1997-11-05/health/9711_05_managed.care_1_hmos-susan-pisano-drew-altman?_s=PM:HEALTH</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Sandy Williamson</td><td width="185">3/15/2013 6:36:24 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>I agree with you Peru,if we are paying the premium and know what kind of doctor we need to see we should be able to pick up the phone and make appointment.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/16/2013 8:03:12 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>Thanks Peru for the first article.Choice is the main factor to consumers looking away from HMOs. The question is are we willing to pay more for choice to see specialists? </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/16/2013 8:17:57 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>I think many of us automatically equate specialists with more higher fees. The typical first reaction I have when I recommend a referral to a specialist is "That's going to be very expensive, isn't it, Doc?" Yet most people understand that specialists undergo additional training in their field to provide a higher level of care for those cases that require it. And they understand that if they want the best possible outcome, sometimes only the specialist can give the pet a chance for that outcome.There is a particular clinic in the northern suburbs of Chicago where I have always referred my back cases. Initially I did that because of my mentor's faith in their skills, but later it was based on my own experience with my patients. They seldom performed surgery that wasn't going to do the pet any good (i.e. the condition was no longer acute but now chronic, meaning permanent damage), and yet the owners were content that they had done all they could for their pet. And for those who did undergo the surgery, the pets typically returned to us within a few months bouncy and happy. Compared to the human friends and acquaintances I know who have undergone similar procedures, I would really rather have these specialists do the surgery on <i>my</i> back, should I ever need it! Even after I started working at the emergency clinic in Rockford, over sixty miles away, I still referred cases to this clinic. And the clients almost always came back thanking me for the referral, even though it was very expensive for them.If people are willing to pay more for specialty care for their pets, it stands to reason that they would do the same for themselves or their children if they felt it was necessary. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/17/2013 7:07:22 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td>I would pay more to see the specialist, however it is not always affordable. To me, your health, whether we are talking physical or mental, is one of the most important things that most people have control of. If you can prevent yourself from getting ill or have the means to seek the best treatment, then you should. Its the best way to remain productive in society and to be able to take care of your loved ones.However, the few times when I have looked at seeking care from an out-of-network specialist, it was going to be an immediate up front payment of several hundred dollars, which I did not have at the time. Fortunately it was a matter of choice so I was able to choose a less expensive option.I feel sorry for those that dont really a choice but to seek out a specialist and dont really have to money. That drives people to do desperate things, or choose the option of just letting their health deteriorate.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Teresa O'Brien</td><td width="185">3/16/2013 11:59:55 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td><b>Modified:</b>3/17/2013 12:08 AM</td></tr><tr><td width="148"></td><td>I agree with you, Peru and my classmates that we should be able to choose to see a specialist and one of our choice in our health care decisions. This is an example of the breakdown occurring in our healthcare system today. When my 1 year old fell down the stairs, we decided to take him into the Prompt Care to be safe. Once there, we hade to wait an extended amount of time, to NOT be seen - after paying our co pay, were told we had to go to the emergency room due to his age. They couldn't refund my money, they had to let it go through insurance so they could process the credit back - which ended up causing problems for the ER billing. Then we found the Prompt Care was not classified as an Urgent Care, so our policy no longer covered the facility. Unfortunately, we had 2 visits within 2weeks before we learned they were not covered - so the whole ordeal cost almost $1000 out of pocket. Thank goodness everyone was fine - but my checkbook needed some resuscitation.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="180"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/17/2013 7:13:38 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="203"></td><td>Teresa, that's the part I hate about insurance and healthcare. There has been one too many times where I have been to see a primary care doctor and left feeling like it was a complete waste of time. But the co-pay for the visit still had to be paid at the time of the visit. I am sorry to hear about your experience with your child. Sometimes its not as bad when you can get a little piece of mind knowing your kid is OK.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="235"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Teresa O'Brien</td><td width="185">3/17/2013 11:57:20 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="258"></td><td><b>Modified:</b>3/17/2013 11:58 PM</td></tr><tr><td width="258"></td><td>You are right, David - that peace of mind is worth it and when it comes to my children, and like most parents, I make sure they get the medical care they need, then deal with the expense later. This ordeal also prompted me to do more research on the providers in our area that were included in our network since we were new to the area with this insurance plan. That way in an emergency I was ready with where I needed to go & still be covered.Unfortunately, I found that all of the Prompt & Urgent Care facilities within a 100 mile radius were not inclded in my plan and the local hospital Emergency room is the only type of facility where I could go without an appointment in a situation where I needed a doctor and the children's physician could not see them. It seems that it would make sense for the insurance company to review including these facilities to avoid the higher costs emergency rooms. To me that decision results in the abuse of ERs - another healthcare topic in and of itself. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Jorge Amador</td><td width="185">3/15/2013 5:47:52 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Professor, I believe this issue is a glaring one as indeed as a patient we should be able to get the services we are requesting and not be told that certain services are not going to be offered due to not being covered. One huge example that I use for this type of behavior is how I spent a Month home from being sick and could not get a straight answer on what was wrong until I was referred to a specialist where he found out what I truly had and gave me the medication I needed to get better. Yet I know my plan is not an HMO but it would have been good to have seen the specialist first and not miss that much work. In an HMO case that could of caused more headaches to the patient since they would have to be the ones determining if it was a "true emergency". Kind of like the patient in the article and if you are a parent and think your child is having a serious illness you seek emergency assistance without thinking on whether it is a true emergency in the eyes of the HMO.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Antonio Walker</td><td width="185">3/15/2013 7:26:44 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td><b>Modified:</b>3/15/2013 7:30 PM</td></tr><tr><td width="93"></td><td>Mrs. Warren,I never realized how many people wanted to see changes such as access to specialist in HMOs. I consider myself in good health and have rarely needed to see a specialist over the years. However, this seems to be common theme with consumers with HMOs. I must say you have to pay for quality. I prefer a PPO however; the HMO fits into my budget. The cost for better care and specialist access depends on the consumer’s budget and care requirement.“What remains to be seen, though, is just how much extra Americans are willing to spend for better healthcare. The <a href="http://www.kff.org/" target="_new">Kaiser Family Foundation</a> recently reported an all-too-telling survey of Americans' ambivalent attitudes on these issues. Some 1,200 people across the country were asked if they supported the types of reforms included in most pending HMO bills. As much as 80% to 90% of respondents initially said they wanted to see pro-consumer safeguards such as better appeal rights and easier access to specialists. Then respondents were asked if they would be willing to have health care premiums increase a few dollars extra each month to achieve such measures. Favorable responses dropped below 50%. When pollsters asked if people would stomach premium increases of $15 a month or higher, barely one-quarter of the public still had an appetite for reform (pbs.org 1998).”pbs.org (1998) The Outlook for HMOs: <i>The High Price for Healthcare</i>. Retrieved March 15, 2013 <a href="http://www.pbs.org/wgbh/pages/frontline/shows/hmo/etc/outlook.html">http://www.pbs.org/wgbh/pages/frontline/shows/hmo/etc/outlook.html</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Article Review - Backlash of HMOs </b></td><td nowrap="nowrap" width="200">Julie Hicks</td><td width="185">3/15/2013 11:55:02 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>I agree Antonio. The best thing about HMO is the cost . PPO are very expensive for most but do offer ease when obtaining a specialist.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Lack of support </b></td><td nowrap="nowrap" width="200">Pedro Huertas</td><td width="185">3/15/2013 11:10:54 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>HMOs could impact the physician’s behavior by not providing them with the appropriate level of support. As a program manager I find myself in the middle of the conflict between the HMOs and the organization. We used to be the only provider of dental services for Medicaid patients in the area, but things have change since HMOs came onboard. The main issue we have with HMOs relates to the policies and procedures. We experience a high amount of billing and referral denials even though we follow the proper procedures as explained to us. In addition, the territory representative seems to be overwhelmed with the amount of providers in the area. Unfortunately, as part of the Department of Health we have no choice, but to work around the many difficulties we confront.<a href="http://www.nber.org/bah/winter03/w9091.html">http://www.nber.org/bah/winter03/w9091.html</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Lack of support </b></td><td nowrap="nowrap" width="200">Tatiania Tabb</td><td width="185">3/15/2013 12:24:11 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Pedro, I found your above post very informative and well written. The level of support that HMO provides for physicians is seem to none; you basically have to take what you can get as a provider in regards to HMO plans. Another issue that I think HMO plans have is that there policies change to much and this frustrates the physician. Everyday there are policy changes and this makes the physician frustrated and skeptical to be involved with such a changing-by the day type of insurance plan.</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Lack of support </b></td><td nowrap="nowrap" width="200">Brenda Grant</td><td width="185">3/16/2013 5:19:02 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>In addition there cannot be a clear explanation of the changes. When I worked at a physician's office there were changes constantly...nearly daily. When we would question the changes to get clarification we would have somebody read us policy. What we were looking for was somebody to clearly explain to us exactly what had changed and how it was going to affect us. We could read the policy.... we were looking for somebody to take a bit of the excessive stress from us and simply explain the changes to us so that we could comply. But why would they want to do that? HMMM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Negative Physician Behaviour due to HMO </b></td><td nowrap="nowrap" width="200">Satchit Ladwa</td><td width="185">3/15/2013 11:40:44 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Physicians and their authorized clinical staff work in a complex and emotionally charged atmosphere. The physician’s behavior is expected to align itself with the expectations of the managed-care organization. According to our lecture, there are eight main aspects of physician-practice behavior. They are detailed as follows...- Environment, which is the continuously changing work environment. There are work pressures that drive up medical costs, shifting population demographics, advances in medical interventions, changes in drug cost, shifts in focus to quality and outcomes plus cost, and an increased focus on overall practice behavior.- Medical Education: Formal medical education often has an impact on a physician’s attitude about managed care. Formal medical education addresses clinical approaches to patient care and increases one's knowledge and understanding of medical care.- Autonomy and Control Needs: There is often a conflict between a physician’s need for autonomy and the controlling aspect of managed care.- Role Conflict: Physicians are often viewed as patients’ advocates, but they are faced with the challenge of rationing care. Such situations can cause the physician to feel conflicted between his or her duties to a patient and his or her duties to the managed-care plan.- Understanding the Plan: Some conflict may result from a physician's lack of understanding about the insurance function of the plan.- Bad Habits: Physicians may apply bad habits to clinical practice. These bad habits are often not cost effective and are difficult to change.- Poor Understanding of Economics: Physicians and business administrators may not understand the economics of the plan.- Poor Differentiation Among Competing Plans: similarity of competing plans can be a source of confusion for physicians. This problem is worsened when patients switch to different plans. To combat this confusion, plans must increase communication with physicians and staff.Week 2 lecture for HSM 546 (Health Insurance and Managed Care), Professor Johnson-Warren </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Negative Physician Behaviour due to HMO </b></td><td nowrap="nowrap" width="200">Elena Hallars</td><td width="185">3/16/2013 11:03:43 AM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>In this youtube clip on negative physician behavior the one strategy that works is 360 degree evaluations and coaching. This method works because if you show people that their not good with data proving it then they will realize they have to change. This method is time consuming but replacing doctors costs alot more. Another possible strategy is to that financial goals can help them by putting funds back into the programs the doctors care about. Management must keep promisesas if they don't this will result in negative behavior where it would cause culture problems<a href="http://www.youtube.com/watch?v=zO5eagkdknk">http://www.youtube.com/watch?v=zO5eagkdknk</a></td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Consumerism </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/16/2013 8:06:13 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td><p align="center">Given the discussion and issues surrounding any degree of healthcare reform, how might consumerism help the uninsured?</p> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Latia Phelps</td><td width="185">3/16/2013 11:26:24 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>By giving the uninsured more control over their healthcare a consumerism plan will help those who do not go to the doctor as often to still have health care. According to Aetna Healthcare:<b>Q. Does consumerism in health care <i>really</i> address the problem of the uninsured?</b>A. Consumerism in health care brings us closer to solving the problem of the uninsured. As some correctly point out, HSAs, HRAs and HDHPs alone will not make insurance affordable for everyone, but the lower premiums of these consumer-directed products make it significantly easier for uninsured individuals to purchase medical coverage. In fact, a May 2005 study by America's Health Insurance Plans found that of the 438,000 people who purchased an HSA in 2004, 30 percent were previously uninsured. This is significant because the Institute of Medicine estimates that at least 18,000 Americans die prematurely each year solely because they lack health coverage. (<a href="https://www1.aetna.com/about/aoti/aetna_perspective/consumerism_healthcare.html">https://www1.aetna.com/about/aoti/aetna_perspective/consumerism_healthcare.html</a>)</td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">David Judkins</td><td width="185">3/17/2013 7:28:54 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>You revealed some very interesting facts in your post Latia. It is very sad that at least 18,000 Americans die prematurely each year due to the lack of health coverage, but that is really not all that surprising. Most people cant afford health care if they dont have some type of employer based insurance coverage. We have been dealing with unemployment rates of 8 and 9%, and even higher in some areas. That is hundreds of thousands of Americans that dont jobs and cant afford to pay for health care needs. We know these people are showing up and emergency departments across the country for basic health needs and most of the amounts charged for treatments are having to be written off. It does not make sense to continue this way because the money for these services is going to come out of somebody's pocket one way or another. So if consumerism is going to help reduce premiums then I am all for it.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Julie Gildemeister</td><td width="185">3/17/2013 1:59:39 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>According to dictionary.reference.com:<i>con·sum·er·ism [kuhn-soo-muh-riz-uhm]noun1. a modern movement for the protection of the consumer against useless, inferior, or dangerous products, misleading advertising, unfair pricing, etc.2. the concept that an ever-expanding consumption of goods is advantageous to the economy.3. the fact or practice of an increasing consumption of goods: a critic of American consumerism.</i>It's wise to first define what we mean by consumerism in the context of this discussion. It would seem that the first definition above is the most appropriate definition for our purposes.That said, who is responsible for the protection of the consumer? Isn't that what our governments are trying to do? Are they doing a good job of it? Why? Why not? Should they do more? How can they? If they shouldn't be involved in consumerism in the healthcare industry, who should be? These are all questions I find myself asking as I work through this course. </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Satchit Ladwa</td><td width="185">3/17/2013 4:38:55 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>This is a good topic worth discussing. I think American "consumerism" in healthcare will help the uninsured due to the Affordable Care Act (ACA) which was passed by President Obama. Because of the ACA, nearly "32 million people will gain coverage under the law through an expansion of Medicaid and tax credits." (IHCC) As a result, low- and moderate-income people will be able to purchase coverage through the new insurance exchanges.http://www.theihcc.com/en/communities/policy_legislation/uninsured-but-not-yet-informed_grz102p7.html </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/17/2013 10:48:48 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>Thanks Satchit. It is a good topic worth discussing.There is a timeline for each portion of healthcare reform and there are many uninsured people waiting for this to occur. Some would say that the stats are not correct---that we may have more uninsured people than we have actually noted. I would agree. Medicaid will be an additional advantage for those who do not currently qualify but will with the expansion. We have a variety of new policies that will help the uninsured but as you have stated---we have not reached this group of people with marketing and education. </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Jose Valderama-Sierra</td><td width="185">3/17/2013 8:03:02 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>THis is kind of a convoluted issue, even more now that American Health Care will be universal. That is, Government will have a bigger responsibility in the health of the people. Is it all Gov't reponsibity to create jobs for the country? Should government interfer with the healthcare reform of Americans ? It is Government's responsibility to manage a society which is most conducive to a successful and comfortable lifestyle for the majority of its citizens. This debate argues that yes, Government needs to have a role in the welfare and health of its people: http://www.npr.org/templates/story/story.php?storyId=94812584 </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Guertty Lopez</td><td width="185">3/17/2013 8:43:40 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>An article published by <i>The Wall Street Journal</i> states that the question of whether consumerism is the wave of the future remains open, although some surveys suggest these plans have significant growth potential. Advocates say these plans ultimately will help to decrease the number of uninsured, encourage cost-consciousness among consumers and increase the amount of information on the cost and quality of providers.The article analyzes three annual surveys that were released by the nonpartisan Employee Benefit Research Institute (EBRI) and the Commonwealth Fund produced mixed results that amount to neither a ringing endorsement nor a total denunciation of consumer-driven (and high-deductible) plans. Among its major findings:<ul> <li><i>Enrollment remains low but is growing:</i> Overall, 7.5 million adults ages 21 - 64 with private insurance, representing about 7 percent of that market, were either in a consumer-driven or a high-deductible health plan in 2007.</li> <li><i>No impact on the uninsured:</i> Adults in consumer-driven plans were no more likely to have been uninsured before enrolling than those in more comprehensive plans.</li> <li><i>High-income enrollees:</i>Of the adults enrolled last year in consumer-driven plans, 31 percent were in households with incomes of $100,000 or more, up from 22 percent in 2005. That compared with just 19 percent with incomes under $50,000, down from 33 percent in 2005.</li> <li><i>Satisfaction rates are lower but increasing:</i> Consumer-driven plan participants continue to be less satisfied with various aspects of their health plan than those with more comprehensive insurance. However, the EBRI/Commonwealth survey found they were somewhat more satisfied with their plan in 2007 than they were in the two previous years.</li> <li><i>Participants are more cost-conscious:</i> Adults in consumer-driven plans are more cost-conscious in their health-care decision making than those in more comprehensive plans, and more likely to talk to their doctors about treatment options or to ask for a less costly generic drug.</li> <li><i>More missed care:</i>Individuals in consumer-driven plans report using health services at rates similar to those in comprehensive plans. But in all three annual EBRI/Commonwealth surveys, people in these plans were more likely to skimp on needed medical care or medications because of cost than were those in more comprehensive plans.</li> <li><i>Health-care information still not available:</i>Over the three years of the EBRI/Commonwealth survey, no significant gains were reported by plan participants in the amount of information available on provider cost and quality, two keys to making the plans a success. Other research suggests that consumer-driven plans may be doomed if the lack of consumer information and education is not addressed.</li></ul>Whether the consumer-directed plans are saving money, the article stated that there is no significant saving yet. It mentioned a new report by Milliman and the National Business Group on Health (NBGH), looking at six employers' plans with 30,000 workers, found that consumer-directed plans created a "modest" 1.5 percent savings for employers. Higher cost-sharing by workers discouraged utilization, accounting for the savings. The results reinforced the need for better consumer information, Milliman and NBGH said. Actual savings are likely to increase when participants have the patient education resources they need to compare and shop for health care based on quality and cost.The article concludes by saying that the future for consumer-driven health plans could be a slow growth because employers are certain to continue looking for ways to control their health-care costs and right now consumer-driven plans are the vehicle of choice, but it stated that this may well change if these plans fail to show proven savings or if workers find themselves stuck only with the higher bills and none of the new information and control that are supposed to be part of the package. It further stated that with both benefits managers and at least some workers very interested in these plans, they seem unlikely to go away any time soon.<i>The Wall Street Journal</i>, Consumer-Driven Health Plans: Are They Working? by Paul Fronstin and John McDonald, EBRI.<a href="http://online.wsj.com/ad/employeebenefits-consumer_driven_plans.html">http://online.wsj.com/ad/employeebenefits-consumer_driven_plans.html</a> </td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="70"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Laura Wimberly</td><td width="185">3/17/2013 10:57:35 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="93"></td><td>Uninsured patients may be broadly divided into two groups – those with low income or preexisting conditions, who can’t afford insurance; and those who are generally healthy, have moderate or high incomes, and choose not to obtain insurance. The individual mandate will impact mainly the latter group – a group with very low rates of uncompensated care, and very low consumption of health care at all.Of the low-income uninsured, most will be either covered by the health reform law’s vast expansion of Medicaid eligibility (thus satisfying the mandate without buying insurance), or exempted from the mandate (if they don’t qualify for Medicaid but face insurance premiums higher than 8 percent of their income). Those unlawfully present in the United States are also exempt. Individuals with expensive pre-existing conditions will be able to obtain coverage at premiums substantially below their health care expenditures, and thus have a powerful incentive to obtain insurance even without that mandateSource: Communities: Regulatory & Compliance - What problem does the individual mandate solve? by Robert Book<a href="http://www.theihcc.com/en/communities/policy_legislation/what-problem-does-the-individual-mandate-solve_gyvnkeqx.html">http://www.theihcc.com/en/communities/policy_legislation/what-problem-does-the-individual-mandate-solve_gyvnkeqx.html</a> </td></tr></tbody></table></td></tr></tbody></table> <table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="125"></td><td width="14"></td><td width="0"><b>RE: Consumerism </b></td><td nowrap="nowrap" width="200">Latia Phelps</td><td width="185">3/17/2013 11:24:32 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="148"></td><td>I agree with you Laura, and thank you for the article within your post. I never thought about those who can afford insurance but choose to not have it, now we turn on the television and we hear about health care is always the poor who cannot afford it. It we are all lumped together and forced to have a universal health insurance I know now that is not just the low income that will be affected. The choice to and not to have insurance of some kind can also be a burden to a healthy person who has money and choose not to use the health insurance that they are paying for without consent.</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="15"></td><td width="14"></td><td width="0"><b>Week 2 Wrap UP Thread 2 </b></td><td nowrap="nowrap" width="200">Professor Johnson-Warren</td><td width="185">3/17/2013 10:54:15 PM</td></tr></tbody></table></td></tr><tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td width="38"></td><td>Well, at least no one completely disliked an HMO this week? Ok. There were a few . Nevertheless, we know that there's negative physician behavior but we also have an idea to why. We want choice. The physician's want freedom. We want low premiums. The physician's want higher reimbursements. It's a difficult battle to win on both sides of the coin. In the end, we have our own personal experiences with the various types of managed care plans. This is want develops our behavior. Let's continue to learn more as we move to week 3.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table>
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