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MARK PROBERT wrote in a message to ALAN RACKMILL:
 MP> ALAN RACKMILL was thinking about Help! Ideas Needed. and
 MP> keyed into  cyberspace:
AR>Bob Moylan wrote in a message to Kalera Ashley:
AR> BM> Kalera Ashley (On 03 Mar 98) said this..? to Mark Probert
AR>MP> KA>What disturbs me most is how many GPs are willing to prescribe
AR>MP> KA>these medications with little or no background in diagnosis
AR>MP> KA>and treatment of the  conditions for which they are
AR>appropriate.  KA> MP>
AR>MP> How do you know that there are so **many** GPs who do this?
AR> KA> Insurance company policy.
AR> BM>  You have evidence that this is 'insurance company' policy?
AR> KA> After observing it a couple of times, I asked my doctor. Aetna,
AR> KA> among other insurance carriers, discourages GPs from doing
AR> KA> referrals and actually offers kickbacks for NOT doing referrals,
AR> BM>  Aetna offers kickbacks?  Sounds illegal to me. It also
AR> BM> sounds like a  fairy tale.  I rather doubt that your doctor
AR> BM> told you that "Aetna,  among other insurance carriers"
AR> BM> offers kickbacks.  Any MD caught  taking a kickback for not
AR> BM> making referrals if/when indicated would  more than likely
AR> BM> lose his/her license and his/her malpractice  insurance
AR> BM> company would have to defend a suit.
AR> KA> so many doctors are
AR> KA> in the uncomfortable position of being unofficially pressured to
AR> KA> prescribe medications they aren't really qualified to prescribe.
AR> BM>  Evidence....
AR>There have been law suits about non-referrals and legislation to stop
AR>that practice in my area.
AR>Basically, the referral money si set up like this:
AR>The doctor is paid X dollars for each patient that he cares for under
AR>the plan. This is his "salary".
AR>Like any good corporation, these companies give year end bonuses.
AR>The doctor is told at the beginning of the year how much that bonus
AR>will be. However, the doctor is told that the bonus figure given will
AR>be reduced if the number of referals exceeds a certain amount.
AR>The higher the number, the lower the year end bonus.
AR>This gives the doctor a financial incentive to not refer.
 MP> In NY, the practice was that each specialty set up a pool.
 MP> If a GP  referred to a specialist more than a certain number
 MP> of times, that  specialty pool was "re-imbursed" for the
 MP> excess "cost". At the end of  the year, the pools were
 MP> divided amongst members.
 MP> See the pressure?
Yep.
It is basically the same.
Instead of doing it on a doctor by doctor basis, they grouped them together.
Thereby adding peer pressure to not refer for that group.
And the pool (bonus) was reduced when the number of refferals got over a 
certain point.
Any way you want to look at it, it is a bonus for NOT referring patients.
Alan
Team OS/2,
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