In the ongoing struggle for supremacy in the healthcare industry, organized medicine has largely failed in its effort to stop the nationwide consolidation of the health insurance industry through mergers and acquisitions. That consolidation has given insurers a sledgehammer to use in negotiations with physicians over the prices theyll pay for the physicians services. But physician leaders are coming up with new and creative ways to fight back against their financial and clinical oppressors.
As Modern Physician frequent contributor Jay Greene reports in this issues Top Story, a local medical society swallowed hard and went public with its complaints against six area health insurers. At a news conference in December 2007, the Harris County (Texas) Medical Society released the results of a survey of nearly 500 of its physician members. As you can imagine, the survey found widespread dissatisfaction among the physicians with the companies that pay their bills. And we use the word pay loosely. Some 64% of the respondents said insurers pay less than their contracted rate, and 69% said insurers dont pay them in a prompt fashion. The effort was one of the first that we can remember in which physicians turned the table on insurers, which routinely are rating physicians. In Harris County, the physicians are now rating their insurers.
Then just last week, organized medicine lit the fuse of a big bomb that the state of New York dropped on insurers. New York Attorney General Andrew Cuomo said he plans to file a lawsuit against UnitedHealth Group, the nations largest health insurer, for allegedly arbitrarily lowering the rates it pays to physicians and other healthcare providers. UnitedHealth allegedly did this by manipulating data on usual, customary and reasonable, or UCR, charges generated by its data subsidiary, Ingenix.
The promised legal action was supported by the American Medical Association, whose president-elect, Nancy Nielsen, M.D., attended the news conference at Cuomos side.
In a written statement released by the AMA, Nielsen said, Unfortunately, there is no reason to think this is an isolated situation. In fact, the circumstances suggest that the practice of using skewed UCR amounts is widespread in the health insurance industry.
And theres no reason to think that the acrimony between physicians and insurers is going to end anytime soon, as organized medicine has decided to take the fight to health insurers both locally and nationally.