Cost-Effective Care ─ Declining Reimbursements Hurting Family Physicians

As a family physician, I am tired of the rhetoric from Dr. Terry Rogers and King County Medical Blue Shield (The Times, Nov. 21). For seven years they have been saying that the cost-effective providers will be rewarded, yet year after year, the high spending goes on in hospitals and specialty care, while the cost-conscious family physicians feel the pinch of declining reimbursements for basic medical care.

One by one, family doctors are quietly going out of business in this county, driven out by dwindling reimbursements forced on them by contracts with insurers like King County Medical Blue Shield. I am tired of watching dozens of the best and brightest, most dedicated family physicians in this community settle for a salaried position with a hospital or a commission in the Navy, simply because they were not paid fairly for their hard work in private practice.

We need more family physicians, not fewer. Yet the incentive to choose family practice as a career goes down with each year of declining reimbursements, regardless of the rhetoric. I hold the payors responsible. As every study has shown, family physicians undercharge and are underpaid for the value of their work, in contrast to many other areas of medical and hospital care. For every dollar in care they actually deliver, family doctors save the system many dollars in potentially more expensive care. Patients are willing and often try to pay the difference in insurance reimbursements, but are blocked by the insurance contracts. Yet payors like KCM and Medicare have failed to act responsibly to increase reimbursements to family practice and the other primary care fields. We simply cannot afford to let family doctors go out of practice.

It is time for the insurers to step up and pay for the cost-effective and high-quality care that patients are receiving, not just to whittle away at selected excesses that create direct savings for the insurance companies. Charles L. Wilson, M.D. Seattle

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