Doctors are pawns of the health care system

Doctors and other caretakers are the pawns of the health care system. We provide the services that allow hospitals and medical groups to bring in big revenue. Unless we are contracting directly with insurers, doctors will never realize the true financial firepower that we have. As the health care environment evolves, we are seeing fewer individual physician-owned groups and more conglomerates. The larger the system that we belong in, the greater number of layers of complexity we face.

The WSJ recently published an article discussing contracts that large hospital systems have with insurance companies that theoretically reduces competition and obfuscates costs. Basically, there are two conclusions of the article:

Hospitals can make agreements with insurance companies that prevent the insurance company from offering contracts to competitors without including them.
As a patient, it is common not to know the cost of a medical treatment until you get the bill. Many families with high deductible plans suffer since they cannot shop around for the best price.

These are interesting and valid points but it is impossible to understand the complexities of the health care system in one’s entire career, yet alone one article.

Neither the hospitals nor the insurance companies are victims

The WSJ article paints a negative view of mega hospitals as aggressors who prevent competition by restricting insurance companies from negotiating with lower cost providers. There is indeed something awry with restrictive language in contracts, but we have to realize that this is simply a business. Of course, McDonald’s wants everyone to eat their burgers. If the insurance company is willing to make an agreement, you’d also bet that they are benefiting too. The insurance company always wins. It doesn’t matter what they sell, whether it’s life policies, health policies, whole life policies … the math always works out in favor of the insurer. The patients and health care workers on the field are actually the ones that suffer.

Think about it: If Hospital A is willing to accept less pay than Hospital B for the same services, clearly Hospital A has figured out how to lower costs: (1) Hospital A is able to operate more efficiently and (2) Hospital A pays its workers less. Don’t forget that you, the doctor, is the worker getting less pay for the same work. Your work is paying for the management to make the rules. If you don’t like what they are doing, then you have the choice to leave. The hospital will always be able to find someone else to replace you.

Pawns, after all, are dispensable but needed to win the game.

Doctors get the short end of the stick

Those of us involved with direct patient care have all encountered situations where patients leave our practice due to changes in their health insurance. It’s an interesting phenomenon like a reluctant break-up: the patient claims that their doctor is great but due to a change in their health insurance, they have go elsewhere to an unknown entity. It doesn’t matter if the doctor has taken care of them for decades either. Money talks louder than one’s health, but that is the unfortunate truth of health care.

I’ve certainly had colleagues who have had patients tell them that their prices are “too high.” Ironically these price differentials may be a difference between a $50 copay and a $35 copay office visit, all dictated by an insurance contract beyond the control of the individual physician. Sometimes plans that require the lower copay actually generate bigger bills on the backend and pay the doctor less, which isn’t obvious to the patient. If I were only paid the copay to evaluate whether someone needed to get a carotid endarterectomy, I would have quit my job long ago and become an organic farmer. This situation reflects the confusion in an opaque health care system. If my patients are coming to me for their knee surgeries because they think that I am the most economical option, there is something wrong with the system. Health care shouldn’t be a race to the lowest bidder.

The case to untie yourself from the system

In American chess, there is a rule whereby pawns can become promoted to whatever piece the player chooses once the pawn reaches the end of the board. This is called, “pawn promotion.” It’s about time that doctors find a way to get that pawn promotion.

We each have to define what our pawn promotion means to us. Does it mean financial independence? Does it mean putting yourself in a position to affect health care change? Is it a way to lift our fellow physicians from the shackles of our profession? I certainly don’t want to spend the rest of my career clicking through radio boxes and drop-down menus so that someone else can tell me how meaningful my quality of care is. It’s time for doctors to wake up and figure out the best way we can use our skills to benefit our patients without shortchanging ourselves.