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Derms dump managed care headaches


National report — As have physicians in other specialties, dermatologists have begun abandoning HMOs and other managed care plans in an effort to get timely, fair compensation directly from patients.

Succeeding with this approach, experts tell Dermatology Times, demands a solid business base, a stout constitution and, sometimes, luck.

"Doctors who give up on managed care are definitely becoming more prevalent," says Joel Schlessinger, M.D., Omaha-based solo private practitioner who is board-certified in dermatology and general cosmetic surgery. "But in many parts of the country, abandoning managed care isn't something many of us can do and continue to thrive. On the other hand, keeping an insurance plan that pays late, pays extraordinarily poorly or keeps claims in limbo for months eventually will hurt one's bottom line significantly."

But, he says, subspecialists such as Mohs surgeons "must take virtually all insurance because one doesn't want to turn people away who need treatment, and one doesn't want referral sources to have to think about where they're sending people."

Don't need it

"I believe one can succeed without managed care wherever one is located," counters Deborah L. Moritz, M.D., a solo practitioner in Mansfield, Ohio, who accepts no insurance except Medicare. "But one must look at it in that what one is hoping to do is to better the patient, and to use one's time as a physician more wisely. Instead of reading contracts, for example, I can devote more time to keeping abreast of new developments in dermatology or attending conferences."

Her patients feel they get their money's worth, she says.

Since dumping a handful of common carriers, Dr. Moritz says, "I'm not going to say I give better care. It's probably more about the overall approach to the patient. I tell my staff these people are paying for a service, and they need to be treated with respect. If they need a little extra time, my staff will allow them that, rather than requiring a second visit."

Bruce Deitchman, M.D., credits his practice's ability to flourish without managed care to good fortune and good patient service.

"I was fortunate to be in a position where I was associated with other dermatologists (as both a colleague practicing in the same office and as a colleague covering for other dermatologists) who were not taking insurances and were established as top-tier dermatologists in the New York metropolitan area," Dr. Deitchman, a Manhattan-based general dermatologist, says.

Like his associates, he says, "I make sure my staff is polite. I routinely return phone calls quickly. I call all patients with biopsy or lab results, and try to give the kind of service I would want from my own doctor. I always keep a few open appointments for emergencies or new patients who absolutely must be seen, even if it means on any given day I have a few openings which do not fill. I'm not sure this can be done everywhere in the country - it is more easily done in relatively affluent areas where people's time is important, and they understand the abstract concept of paying for information."

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