To the Editor:

I’m sure quality improvement is an excellent thing for a practice to do. I’ve advocated for it for most of my admittedly short time (11 years) in practice. But I’m concerned about the apparently gratuitous attacks on insurers made in the article “Making Quality and Service Pay: Part 1, The Internal Environment” [October 2000, page 48]. I’m no fan of the current health care insurance system (or nonsystem), but I’m not sure quality improvement should be based on what insurers will or will not pay. Some of the suggestions just seem to get around insurance companies rather than improve quality.

Author’s response:

I believe Dr. Mannschreck misinterpreted our article. It was not a gratuitous attack on insurers. The article described how practices can incorporate innovations into care even when they’re not reimbursed. It discussed how several new, nonreimbursed care methods can help improve practice finances, and a case study was provided to that effect.

Part 2 of the series [“Making Quality and Service Pay: Part 2, The External Environment,” November/December 2000, page 25] described how some insurers are beginning to change their payment methods in order to reimburse both higher quality care and some new forms of care. Again, case studies were provided.

The articles taken together deliver a specific message: In order to improve both the quality of our care and our service, we need to find fiscally responsible ways of doing so. That requires both physician leadership and insightful insurance partners working toward shared goals of higher quality, better service health care. Examples of this exist today, and we’re encouraged that they will continue to proliferate.