Health insurers and physicians are not partners


On the face of it, this seems like a fairly simple business arrangement. My patients or their employers pay money to a health insurance corporation so they, in turn, have sufficient funds available to pay medical claims for services I render. That simple system seems to work for auto, home, and life insurance.

First of all, a little background about me.  I am a board-certified otolaryngologist who did my residency through the U.S. Navy, completing at Bethesda National Naval Medical Center in 1983.  After three years more of active duty, I started a private practice in 1986.

The mid-80s and 1990s were certainly a different time in which to practice a surgical specialty.  The patients were just as challenging and the procedures just as difficult, if not more so, but in general, I got paid for what I did.  Blue Cross Blue Shield et al. was kind of like a checking account or holding company to collect the premiums and then distribute to physicians payments for services rendered.

Obviously, this website is filled with opinion pieces describing the frustrations physicians challenge in the present.  I doubt if I can say anything more eloquently or accurate than these other writings.

The point I want to discuss may be more applicable to us dinosaurs who are in private practice, not affiliated with any large hospital system, university, or other similar practice situation.  But in here I see myself as somewhat of a partner with the major insurance corporations, and of course the government.

This will, of course, come off as terribly naive, but I keep wondering why my partners want me to struggle daily to survive financially.  I employ seven people, including one PA and one doctor of audiology.  My expenses, including supplies rent insurance and payroll, are of course increasing.  Yet through it all, my “partners” seem to feel that it is appropriate for them to systematically lower what they pay me. All surgical fields have experienced about 20 percent decrease in fee schedules over the last ten years.

They are making it increasingly difficult through prior authorizations, peer review, and other unilateral decisions for me to even take a patient to surgery for an elective procedure.

One would think that the folks who sent me the checks would like me to be successful.  One would think it might be in their best interest to have me actually be somewhat prosperous. Again how naive of me.  However, as any of us on this website know their actual level of contempt for my colleagues and me is astounding.

I realize that all of the questions I ask are rhetorical.  But to me, it cuts to the hard of the matter of the shortsightedness of those in charge behind the scenes of the finances of medicine.  Their game is to generate as much profit as possible in the short-term for themselves without any vision of the future. My game is to take care of real people and pay the bills.

Some partnership.

Thomas Stark is an otolaryngologist.

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