Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, February 22, 2008


Words are power. The words we choose and the words that are thrust upon us by others do far more to shape perceptions than most of us realize.

No, I'm not talking about the word "Provider," although I may at a later date. The word is reimbursement as used in the context of payment for medical services. Here's the dictionary definition of reimbursement:
1. to make repayment for expense or loss incurred
2. to pay back; refund; repay
Reimbursement occurs when one party is responsible for an expense that has been paid by another party. If my office manager goes out and buys stamps for the office out of her own pocket, I reimburse her.

The correct word here is PAYMENT for medical services.

We don't reimburse mechanics for fixing our cars; we PAY them.
We don't reimburse barbers for a shave and a haircut; we PAY them.
We don't reimburse accountants for doing our taxes; we PAY them.

Insurance companies do not reimburse me for services I render to patients who have contracted with them. They PAY me for them (sometimes.)

On the rare occasion when a patient pays me first, the patient may then seek reimbursement from the insurance company. The continued use of the term reimbursement reduces the perception payment for medical services to that of a simple inter-office transaction.

Effective immediately, I call upon Kevin, Panda, the Happy Hospitalist and all the other bloggers so diligently addressing the financial issues confronting and confounding us to stop using the wrong word -- reimbursement -- and replace it with the right one: PAYMENT.

Do this exercise: swap out those words in every post you read about physician PAYMENT and see how much more compelling your arguments become. Words are power.


At Fri Feb 22, 10:30:00 PM, Blogger The Happy Hospitalist said...

You have my WORD!

At Fri Feb 22, 10:45:00 PM, Anonymous Anonymous said...

I agree. Words are very powerful and synonyms aren't exact matches. Each word brings a subtly different image, feeling, or perception to the text that will change its meaning.

This is one of the things I love about writing: finding just the right word.

Also, when two people have a different meaning for the same word or phrase during a discussion, it can get really messed up.

Like complementary and alternative medicine, integrative medicine, or faith based medicine... hint hint.

At Sat Feb 23, 02:56:00 PM, Blogger Artemis said...

Just a thought regarding the use of "reimbursement": [not so] many years ago, if a patient required medical care he or she would pay OUT OF POCKET and be REIMBURSED by the insurance company (remember "Master Medical" plans?); I think it's due to laziness or ineptitude on the part of employees of insurance companies that the word is still used.

I'll do my part to work with my staff to make sure we're using the correct phrasing as well...thanks for bringing the issue to our attention!

At Sat Feb 23, 04:23:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

I think it's because we feel guilty asking people to pay us. Most of us are altruistic and did not go into medicine to make money, but for other reasons. I for one have a lot of trouble discussing money issues with my patients for this reason.

But you are right. We do need to be paid for what we do, and should not be afreaid to say it.

At Sun Feb 24, 08:53:00 PM, Anonymous Anonymous said...

Can you also put your pricing in a brochure, so all your patients know AHEAD of time how much the pap smear costs, how much getting a call about the pap smear costs, and so forth? Surely for the basics there's a set price one can expect to pay, no?

At Mon Feb 25, 11:03:00 AM, Anonymous Anonymous said...

Thank you - I had posted about this on Kevin MD recently as it drives me crazy!

At Mon Feb 25, 01:27:00 PM, Blogger Midwife with a Knife said...

Excellent. And to anon 8:53, I would be happy to my patients some sort of brochure with prices on it. It's an excellent idea. It could go something like:

Uncomplicated pregnancy: $2500
Postpartum visit: $40
Healthy mother and child: Priceless ;)

At Tue Feb 26, 12:03:00 PM, Anonymous Anonymous said...

A brochure with prices may actually be a good idea, but in practice it might end up to be 100 brochures based on what insurance you have and even that may not be accurate.

Every year at work I try to estimate how much my out-of-pocket costs will be, so I can esimate the amount to put to Flexible savings account before taxes. If I put too much, IRS (or employer) will keep the money. So one year, after I switched from an HMO where I had fixed copayments to a PPO where I pay 20% in-network/35% out-of-network, I started calling to figure out what the prices would be. I tried both insurance and the medical group, and I couldn't get an answer from either. The insurance told me - "it'll depend on the code under which the doctor submits is, it is managed by our local branch so it also depends on location...". The medical group told me "our listed price is X right now, it may change next year, and it is likely to be different for your plan. Even though I asked for a few very basic and very common procedures, I couldn't get an answer, not even the estimate. The price that medical group quoted turned out to be inaccurate.

As future showed, it turned out even more complex: after the first visit, medical group submitted bill for X, insurance said "our price is Y", medical group appealled, insurance increased their price to an amount closer to the original price, but still below it.

At Tue Mar 25, 05:52:00 PM, Anonymous Anonymous said...

Very well stated.

I'm pretty convinced that this is not accidental. I think words like this are purposely chosen and promoted with the specific intent of putting us (physicians) at a disadvantage.

It devalues our product/service.

Rather than being paid for something of value that we are supplying, we instead are simply being reimbursed, somewhat begrudgingly, as though we really shouldn't expect it and are just being a bit unreasonable for wanting it.

You already mentioned the word "provider." That one irks me as well.

A similar terminology which I do my best to eliminate is "medical malpractice insurance."

Right off the bat, it puts us at a disadvantage in a suit. The fact that our "medical malpractice insurer" is involved in any way, implies that medical malpractice has occured.

It prejudices people against us. I'm convinced that subconciously it even prejudices us somewhat against ourselves.

Again, I don't think this is accidental.

I know a lot of lawyers, and I don't know a single one who carries "legal malpractice insurance."

I do however know quite a few however who carry "legal liability insurance."

(I also know quite a few who carry no liability insurance of any kind at all. Meanwhile their profession scolds and chastises as unethical and irresponsible any physician who dares take this same strategy. That's another subject however.)

I personally try to force myself to use the term medical liability insurance rather than medical malpractice insurance.

I wish others in our profession would join me in this.

I for one will add "reimbursement" to my list of vocabulary to use more appropriately.

Thanks for that one!


Post a Comment

<< Home