When political sit-ins were more in vogue, a popular ditty for some of these affairs was "We Shall Not Be Moved." That could be the anthem for players in the great managed-care debate.
Sometimes it seems the managed-care companies and their critics are locked in a game of mutually assured destruction. No one will give an inch, no matter how much is lost.
The latest tale of intransigence was related last week (Aug. 14, p. 2) by reporter Laura B. Benko. She looked at what has occurred since UnitedHealthcare's move last November to ditch most of its pre-approval requirements for treatment. The answer, at least as far as the industry goes, is not much.
Few health insurers have followed United's lead, despite the fact that pre-authorization is one of the dumbest business ideas of the 20th century. The practice infuriates patients and providers, who have to persuade a nurse or medically unqualified paper-pusher on a phone a thousand miles away, at a time of stress, that treatment is needed. Employers often get an earful from their workers and switch contracts.
United finally realized that pre-authorization was self-defeating. Scrapping the process freed up $110 million in administrative expenses and trimmed United's operating cost ratio to 16.8% from 17.1% a year ago. Enrollment has grown; exposure to malpractice lawsuits has shrunk.
But the change hasn't satisfied the hard-core managed-care haters in physician and legal circles. They resent any attempt to control medical costs and limit doctors' power. United's clinical profiling of physicians--tracking treatment patterns and comparing them with national norms--is an abomination that replaces pre-authorization, the critics contend.
One team of class-action lawyers has even filed a racketeering lawsuit against United, claiming that eliminating pre-authorization amounts to a "fraudulent scheme" to control physicians and costs.
If this kind of action is a conspiracy, a lot of people are accessories to a crime. Healthcare experts widely applaud the use of evidence-based medicine, clinical guidelines and the tracking of practice patterns to both control costs and secure the best medical outcomes. Any responsible insurer should spend money wisely, and these alternatives are a lot less painful than pre-approval.
Remote call centers and blank checks to providers won't cut it today. The managed-care industry and its foes should drop the line-in-the-sand mentality and join the 21st century.