December 12, 2008

Reimbursement cuts add to strain on doctors

I appreciate Dr. Peter Beilenson's generally sympathetic column regarding the plight of primary care medicine in Maryland ("A growing medical menace," Commentary, Dec. 5). But with all due respect, does anyone actually believe that Medicare and private insurance companies will increase their reimbursement rates for any physicians in the coming year?

Most of my medical colleagues are expecting rate cuts of 10 percent to 20 percent in 2009, which will make maintaining a medical practice virtually impossible for many of us.

Boutique medicine is not for everyone. But at least doctors practicing under this model are still seeing patients and providing care.

Most doctors do not want government bail-outs to survive the current fiscal crisis. We just want to be allowed to receive compensation commensurate to the value of our services.

However, under Medicare and private insurance plans, we have been and will continue to be woefully undercompensated.

Dr. Kenneth Greene, Towson

Let nurse practitioners provide primary care

As president of the Nurse Practitioner Association of Maryland and a resident of Howard County, I totally agree with Dr. Peter Beilenson's column "A growing medical menace" (Commentary, Dec. 5). But one thing that Dr. Beilenson forgot to mention is the role that nurse practitioners can play in resolving the problem of access to health care.

While there are more primary care physicians than nurse practitioners in the United States, the number of nurse practitioners prepared for primary care is growing faster than the number of primary care physicians.

Studies have shown that the quality of the care provided by nurse practitioners is equal to that of the care provided by physicians and that patient satisfaction is higher.

Barriers to care by nurse practitioners need to be removed so that we can provide all the care we are fully qualified to provide.

A recent research report by the Government Accountability Office has shown that preventive care, better care coordination and improved continuity of care lead to better outcomes at reduced costs.

These are all things nurse practitioners do well - because we are nurses first.

Diana Heffner, Ellicott City

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