Doctoring Health Care Health Care Reform


I present interesting cases to colleagues often.  Because it is educational and good for patient care, and because I like to.  But it has been many years since I was mandated to present a case.

It seems that I am not the only doctor exasperated by this pesky new barrier to patient care: “doctors-in-cubicles.”

An old friend and mentor, Dr Richard Kovacs, now chair of the American College of Cardiology’s Board of Governors (and IU guy) has written about these same pre-certification barriers.  Dr Kovacs, being a professor and distinguished ACC official, kindly terms these obstructionists, RBMs (Radiology Benefit Managers.)

I call them “doctors-in-cubicles.”  These cost-cutting doctors have not evaluated your medical problem, but yet stand on the ready to deny your prescribed test or procedure. They force your doctor to spend money on extra office staff.

“We just have to grin and bear it.” Some practices are simply reconciled to the fact that insurance companies will impose regulations that are not value added to the patient or the practice, but must be endured. These practices are adding additional precertification staff, streamlining their processes, and “playing the pre-cert game” to take the process from a 20 minute one to a 5 minute one.

Although one may think that such barriers primarily affects doctors, this would be wrong. This is covert–but rapidly approaching overt–rationing of your medical care.

Sure, the present controllers of care, the profit-conflicted insurance companies, say that the purpose of such cubicle doctors is to help us “providers” select the most efficient and cost-effective (for them) diagnostic imaging, or to advocate bio-safety issues, and even to enhance the quality of diagnostic imaging studies.


I believe that.  Don’t you?