I recently read an article published in The Wall Street Journal on February 9th titled “New Way to Pay Doctors.” It made me realize how fundamentally flawed the debate surrounding our health care system has become. The article describes how several health insurance companies are planning to change the way they pay doctors in order to reduce the cost of care in this country. It suggests that profit-driven doctors are carrying out unnecessary procedures causing inflated health care costs. It mentions United HealthCare, WellPoint and Aetna as companies looking to revise the way they pay physicians to help counter this fundamental flaw in our heath care system. They have come up with new terms that were surely developed by their marketing departments; things like “Value Based Contracting” and “Clinical Integration fees” are being tossed around.
Having worked for nearly 20 years in the managed care industry and for the past 7 as a physician advocate and managed care consultant, representing thousands of physicians across the United States, to say that this article raised my blood pressure would be an understatement. I for one am getting tired of the lack of honesty in these discussions and fed up with the amount of spin doctoring that is taking place with something that may be the single largest issue facing our country today.
If you don’t mind, I’m going to hop on my soapbox for a bit.
I find it more than a bit insulting for insurance companies like United HealthCare and WellPoint to point fingers at physicians as the root cause of health care inflation. To declare that profit-driven physicians performing unnecessary procedures are the cause of health care inflation is not only ridiculous, but also hypocritical. Now don’t get me wrong. As with any industry, I’m sure there are bad doctors out there motivated solely by personal profit. Let’s be honest; there are around 1.5 million doctors in the United States, and to think that a profession of that size doesn’t have its fair share of bad apples is naive. However, taking an example of one bad apple and leaping to the conclusion that it’s widespread is nothing short of irresponsible, dishonest and illogical.
Here’s what really gets me: the hypocrisy of a “for profit” insurance company chiding physician profit making behaviors. First, consider the source: United HealthCare. A few years ago, a former United HealthCare CEO got in trouble for backdating more than $1 billion in stock options, and when forced to leave, he received the largest golden parachute ever given to a U.S. CEO. Part of his going away present from the company was a $6.5 million lump sum and a lifetime salary of $5 million per year. I can see why he would need that because you can’t possibly expect anyone to retire comfortably on the $800 million of backdated stock options that he was allowed to keep after his negotiated settlement with the Securities and Exchange Commission. Now I’m not saying that in a free market economy ruled by capitalism we should limit salaries. What I am saying is that it’s hypocritical to pay a disgraced CEO that amount, and then take high moral ground and scold someone else, physicians for that matter, for possibly being motivated by profits.
I recently negotiated a contract for one of my clients against a representative from United and brought up these facts. The United representative tried to get my client, a physician group, to accept lower reimbursement rates because “they need to adjust to the new reality that physician income needs to go down to help control the cost of health care.” I then pointed out some of the facts mentioned above. The UHC representative said, “I will not apologize for my company’s success or profits.” To which I replied, “And I will not apologize for my client’s income.”
WellPoint is another prime example of corporate hypocrisy. When WellPoint merged with Anthem, there was conflict over the amount of money the top executives from the two companies would receive from the deal. Numbers in the hundreds of millions of dollars were reported. Again, I’m not asking these executives to give back that money or even to defend the fact that they ran a business and got very rich from doing it. What I am asking is for them to stop the duplicity of cashing huge paychecks on Friday, and then on Monday telling the rest of the country that doctors are greedy.
The cause of health care inflation is not that physicians are increasing their incomes by performing unnecessary procedures and testing. If it were, we would expect to see physician income on the rise over the last decade or so, which is not the case. There have been multiple studies over the last 20 years that show physician income in decline when adjusted for inflation. During these same periods, other professions have seen their incomes increase. If doctors are carrying out unnecessary tasks to increase their incomes, they certainly aren’t doing a very good job of it.
So where does this leave us? We still have a major problem with rising health care costs, and really no viable solution. There needs to be an honest discussion and acceptance of the fact that we can’t provide everything for everyone. We need to talk about the impact of lifestyles on health care costs. We need to establish what we can cover, and what will be the individual’s responsibility. Consider how we handle feeding the poor in this country: We provide food stamps to people who otherwise may not be able to feed themselves or their family. This assistance provides for the basic needs of these people, not for dinner at a 5 star restaurant every night.
Why should the health care discussion be any different?
Finally, we need to stop laying all of the blame on physicians. When an insurance company says they are going to change “the way” they pay physicians, what they really mean is that they are going to change “how much” they pay physicians. This is a very dangerous road to travel with potential for a catastrophic conclusion. Where will we be in a few years if we drive down physician income so much that no one wants to become a doctor anymore? Imagine a shortage of physicians and an influx of patients added to our health care system.
Year 2020: Welcome to the self-service clinic. Please type your symptoms into the computer. The computer will print out your prescription. If surgery is necessary we will put you on the waiting list and hope for the best.
To view this article as featured in the March issue of the Physicians News Digest, follow this link:
http://www.physiciansnews.com/2012/03/11/lets-be-honest-uncovering-fundamental-flaws-in-the-health-care-debate/
Having worked for nearly 20 years in the managed care industry and for the past 7 as a physician advocate and managed care consultant, representing thousands of physicians across the United States, to say that this article raised my blood pressure would be an understatement. I for one am getting tired of the lack of honesty in these discussions and fed up with the amount of spin doctoring that is taking place with something that may be the single largest issue facing our country today.
If you don’t mind, I’m going to hop on my soapbox for a bit.
I find it more than a bit insulting for insurance companies like United HealthCare and WellPoint to point fingers at physicians as the root cause of health care inflation. To declare that profit-driven physicians performing unnecessary procedures are the cause of health care inflation is not only ridiculous, but also hypocritical. Now don’t get me wrong. As with any industry, I’m sure there are bad doctors out there motivated solely by personal profit. Let’s be honest; there are around 1.5 million doctors in the United States, and to think that a profession of that size doesn’t have its fair share of bad apples is naive. However, taking an example of one bad apple and leaping to the conclusion that it’s widespread is nothing short of irresponsible, dishonest and illogical.
Here’s what really gets me: the hypocrisy of a “for profit” insurance company chiding physician profit making behaviors. First, consider the source: United HealthCare. A few years ago, a former United HealthCare CEO got in trouble for backdating more than $1 billion in stock options, and when forced to leave, he received the largest golden parachute ever given to a U.S. CEO. Part of his going away present from the company was a $6.5 million lump sum and a lifetime salary of $5 million per year. I can see why he would need that because you can’t possibly expect anyone to retire comfortably on the $800 million of backdated stock options that he was allowed to keep after his negotiated settlement with the Securities and Exchange Commission. Now I’m not saying that in a free market economy ruled by capitalism we should limit salaries. What I am saying is that it’s hypocritical to pay a disgraced CEO that amount, and then take high moral ground and scold someone else, physicians for that matter, for possibly being motivated by profits.
I recently negotiated a contract for one of my clients against a representative from United and brought up these facts. The United representative tried to get my client, a physician group, to accept lower reimbursement rates because “they need to adjust to the new reality that physician income needs to go down to help control the cost of health care.” I then pointed out some of the facts mentioned above. The UHC representative said, “I will not apologize for my company’s success or profits.” To which I replied, “And I will not apologize for my client’s income.”
WellPoint is another prime example of corporate hypocrisy. When WellPoint merged with Anthem, there was conflict over the amount of money the top executives from the two companies would receive from the deal. Numbers in the hundreds of millions of dollars were reported. Again, I’m not asking these executives to give back that money or even to defend the fact that they ran a business and got very rich from doing it. What I am asking is for them to stop the duplicity of cashing huge paychecks on Friday, and then on Monday telling the rest of the country that doctors are greedy.
The cause of health care inflation is not that physicians are increasing their incomes by performing unnecessary procedures and testing. If it were, we would expect to see physician income on the rise over the last decade or so, which is not the case. There have been multiple studies over the last 20 years that show physician income in decline when adjusted for inflation. During these same periods, other professions have seen their incomes increase. If doctors are carrying out unnecessary tasks to increase their incomes, they certainly aren’t doing a very good job of it.
So where does this leave us? We still have a major problem with rising health care costs, and really no viable solution. There needs to be an honest discussion and acceptance of the fact that we can’t provide everything for everyone. We need to talk about the impact of lifestyles on health care costs. We need to establish what we can cover, and what will be the individual’s responsibility. Consider how we handle feeding the poor in this country: We provide food stamps to people who otherwise may not be able to feed themselves or their family. This assistance provides for the basic needs of these people, not for dinner at a 5 star restaurant every night.
Why should the health care discussion be any different?
Finally, we need to stop laying all of the blame on physicians. When an insurance company says they are going to change “the way” they pay physicians, what they really mean is that they are going to change “how much” they pay physicians. This is a very dangerous road to travel with potential for a catastrophic conclusion. Where will we be in a few years if we drive down physician income so much that no one wants to become a doctor anymore? Imagine a shortage of physicians and an influx of patients added to our health care system.
Year 2020: Welcome to the self-service clinic. Please type your symptoms into the computer. The computer will print out your prescription. If surgery is necessary we will put you on the waiting list and hope for the best.
To view this article as featured in the March issue of the Physicians News Digest, follow this link:
http://www.physiciansnews.com/2012/03/11/lets-be-honest-uncovering-fundamental-flaws-in-the-health-care-debate/
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