It turns out the reason the two docs wanted to come out to my office had little to do with my association with BCBS, but was more about they're wanting to see my electronic medical records system (EMR). Physicians have found EMRs to be something of an double-edged sword: while they promise considerable time savings, data accessibility and reduction of errors, they have (in practice) turned out to be (in general) boondoggles. Most EMRs are outrageously expensive (requiring annual fees in addition to the startup costs, if you don't pay the annual fee or the company goes under your patient records could get locked out and inaccessible), slow, cumbersome, and a waste of resources. Often written by people with little clinical experience, they often require the physician to conform to the system's way of evaluating patients and may even work by having the physician select choices from a menu for each phase of an exam. There is much promise in using EMRs, but I haven't seen it realized in practice. I know 2 offices that tried to implement eClinicalWorks in their offices and both abandoned it quickly despite having thrown thousands of dollars at it. I've been using an open-source EMR that doesn't cost an arm and a leg and I'm quite content with it. I had mentioned it to the doctor at my original BCBS PPO appeal and he asked if he could come out and take a look at it. I had forgotten about that, but that seemed to be the main reason they came out. A week ago, I got another letter from Blue Cross saying they upheld their decision after the first appeal. So, if I want to keep having them cover the >50% of my patients with their insurance I have to either continue to fie appeals or give the same level of care they could get anywhere else. I'm appealing again, but I expect it isn't going to last and the days of BCBS PPO coverage will come to an end. The tragedy is that this may lead to a domino effect with all insurances and going to a cash (or credit-card) only practice. It turns out that many physicians who practice a little off the conventional way are cash-only, so I'm not breaking new ground, and will probably survive. I'm mostly worried about all the patients who wouldn't be able to continue to see me: after years of inadequate care, they may get thrown right back to it.
