From a Maternal Health and Pediatric Physician: reasons why we, Physicians, are against Colorado HB 21-1232.
I am a Neonatologist and Pediatrician with a focus on delivering high quality care that supports maternal mental health. I have been a resident of Colorado since 2009. I feel it is important to publicly share my opinion regarding Colorado House Bill 21-1232 since it will impact my service to my patients.
This bill addresses rising health care costs by creating a Colorado Public Option. I support a Public Option; however, the way this bill is written it will close private practices in Colorado and will consolidate primary doctors to work within large hospital systems only or move. Primary doctors consist of pediatricians, internists, and family practice. Physicians serving your community and dedicated to providing preventive care to you and your family. Losing our primary care doctors will be a loss to Colorado. Before diving into the logistics of the bill, let’s start with some background: four years ago I left institutional hospital care and opened NayaCare, a newborn specialty clinic that comes to you. In my role as a Neonatologist, I worked at a local hospital. Over the years, I noticed more of my time devoted to patient medical documentation, attending meetings surrounding how to increase revenue via billing, and learning the complexities of insurance. I had less time for my patients and more energy directed on creating earnings. Leaving the hospital system and focusing on direct primary care including those with medicaid support brought me back to why I became a physician in the first place – caring for my patients, not the hospital’s volume targets or insurance company bottom lines.
Unlike many of the private practice and hospital-based practices, NayaCare managed to care for our patients throughout the pandemic without issues of people being unwilling to come in for office visits. Our in-home, come-to-you care model was already structured for the health and safety of our patients. In addition, we utilized telehealth visits to further care for and protect our patients during this vulnerable time.
Lastly, a note on how health insurance actually works. You, the patient, pays into a policy that supports your family. We, the physicians, are under contract with insurance. When you come to see us, we bill the insurance company for our services delivered. The insurance company, then, decides if they feel our billing/coding/charting suited their service model and pays us accordingly. We usually receive the reimbursement 2 months AFTER your service has been completed. Those insurance payments keep our office open, lights on, and staff employed. If we are not timely in our submission of claim of service, we can lose the money. This is why many clinics have opened a dedicated billing department. Moreover, if we challenge the payment back, we are usually caught up in months of debate, time taken away from our patients. Oh, and here is the kicker, some insurance companies can take back the money that was already allotted to us for the service rendered up to 7 years after the service has been completed. See, this is why we don’t like insurance either.
The bill, which is presented in a complex and convoluted manner, is ill-founded and the consequences of the precedence being created by it are not fully understood by the front-line physicians it directly affects. However, what is immediately made clear with this bill, physicians that do not comply with the participation mandate will be fined and eventually subjected to hearing defending their decision and medical license, putting all private practices and direct primary care physicians at risk of closing or moving. The only option for Colorado patients will be to seek care under large corporate hospitals and care groups that are more concerned with their bottom lines than the quality of patient care.
Also, highly concerning are the advisory board composition which includes only ONE physician seat and an insurance commissioner who has total veto power over the advisory board and who is appointed by the governor every 4 years. How will this board and commissioner model protect patients from a bill that is more concerned with special interests and the business of medicine versus the care of the people of this state?
Again, as mentioned above, I support the theory of a Public Option. This bill, at the bottom line, will drive doctors away from Colorado. I encourage our legislators to create a Public Option that actually serves Coloradans. From a patient perspective, insurance that brings quality care, removes burdens to access care, and renders coverage in wellness services to support preventive medical care. From a physician’s perspective, insurance that removes the cost and administrative burdens of insurance. Insurance that pays us on a timely basis and also is clear on service rendered and reimbursement given, no hidden tricks. A Public Option that does not deny care and places burdens on patients and physicians to defend the medical care decisions.
In a world of innovation, remove the barriers for the physician patient relationship. Stop creating more administrative, red tape layers and squeezing our time away from our patients. Stop making hurdles and mandates on how we should serve our patients. Stop dictating to us how we need to practice medicine and threatening us with penalties and medical license revoking warnings. Stop feeding into the business of medicine. Start supporting physicians and patients rights to deliver and receive quality medical care.
To learn more about this bill, click here.
To contact your Senator, click here.