Changing A Bad System

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=82 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="1e328283.gif"> <div> <FONT SIZE="4" COLOR="#FFFFFF" FACE="Garamond" ><B>PRIMARY CARE PARTNERSHIP</B></FONT><B>    </B><B> |    </B><B> </B><A HREF="index.htm" TARGET="_top" TITLE="PRIMARY CARE PARTNERSHIP"><B>home</B></A></div> <div> back to<B>  </B><A HREF="csh.htm" TARGET="_top" TITLE="Cathleen S. Hood, MD"><B>Cathleen S. Hood, MD</B></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#C0DCC0" TEXT="#080000"> <div> <A HREF="csh.htm" TARGET="_top" TITLE="Cathleen S. Hood, MD"><IMG SRC="03b0e0e0.png" border=0 width="14" height="14" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></A>  <IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14">    <IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14">  <IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14"></div> <bR> </td> <td valign="top" height=398 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Changing A Bad System</div> <bR> <div> When we opened Primary Care Partnership in February 2001, we sought to make a difference: to provide the most competent and professional care possible in a calmer, more caring, and complete way - “partnering” with patients to help them achieve and maintain health.</div> <div> We have been gratified by your response, having to close our practice to new patients several times in order to maintain the quality of care we believe is nothing less than good medicine.</div> <div> But we are practicing medicine at a difficult and challenging time. In an environment already unfavorable to primary medicine, we have continued to face additional, dramatic cost increases with no corresponding increase in reimbursement. Health insurers continue to add policies which usurp large amounts of provider and staff time and question our judgment and professional integrity at every turn - hours on hold, faxing, completing forms, and submitting to inquisitions, known as "prior authorizations," in order to obtain authorization for tests, referrals, and medicines.</div> <div> Constantly working to be as efficient as possible, we - everyone at PCP - have contributed to the continual improvement of our practice management. We continue to push for efficiencies, but believe it is bad medicine to lower our standard of care.</div> <div> Unfortunately, the pressure is very clearly to spend as little time with as many patients as possible, while shouldering the increased workloads and obstacles set in our path by the insurance industry. Furthermore, we are specifically prohibited by the insurers from “balance billing” our patients (as dentists do) for the difference between the shrinking reimbursements and what we believe is fair and reasonable pay for our work.</div> <div> Please understand that our objective is not primarily to create wealth, but merely to keep the doors open. Some of our colleagues have thrown in the towel, leaving medicine entirely, accepting salaried positions in realted industry, or setting up practices completely outside the third-party reimbursement system.</div> <div> We are not ready to give up, but are faced with limited options. We have found it necessary to terminate some of our insurance contracts: Aetna and Cigna contracts were first to be terminated, and UnitedHealth and Blue Cross/Blue Shield of Rhode Island were effective 10/18/03 and 8/30/03, respectively. Affected patients received letters from us and from their insurer. (Notably, any patient insured by RI BCBS whose insurance card has a little suitcase pictured on it may continue to come to Primary Care Partnership and their insurance will pay through MA BCBS.)</div> <div> Our hope is that all our patients will find a way to continue to come to Primary Care Partnership. We will make every effort to accommodate patients bridging the gap until next open enrollment, if necessary. We encourage everyone to opt for a PPO when possible, which will allow patients to submit their own claims for reimbursement after paying our fee. We cannot guarantee that other contracts will not be terminated.  We are endeavoring to maintain Blue Cross/Blue Shield of Massachusetts contracts as they represent a large proportion of our patients, and tend to reimburse more fairly. </div> <div> We will begin to request that patients with insurers we do not contract directly with provide payment at the time of service and submit their own claim for reimbursement (we will provide all documentation), as our costs have become prohibitive.</div> <div> We will continue to update this site as developments warrant. Our plea to you is that you try, with us, to use email to address insurance-related questions which your individual insurer cannot answer, so that our office phone lines remain open for medical problem calls.</div> <div> We thank you for your understanding and cooperation. We are committed to remaining available to take care of your health needs.</div> </td> </tr></table></body>