“Take it or leave it” is not negotiation but coercion.
Physicians have been subject to this tactic for much too long. As an ophthalmologist in clinical practice for nearly four decades, I experienced too often what a recent author on KevinMD described as a one-sided arrangement with a health insurance company. “Here is the fee schedule. Here is the document to sign.” End of story.
If you object to the terms of the contract and attempt to negotiate better terms, you are excluded from the insurance company’s network. I recall an episode of such coercion when the medical director of a large insurance company met with our group of physician-partners to propose that we open an optical shop within the confines of his multispecialty clinic. Our group hired personnel, purchased inventory, and managed the operation, while the health insurance company would take a substantial cut of the revenue. Declining this one-sided offer came with the threat of losing patient referrals for eye care.
Such heavy-handed tactics have been successful for health insurance companies and hospital systems because of their size and reach. The choice for independent physicians: either accept an adverse offer or be excluded from the network. Many doctors have thrown up their hands and become employees of a system that regards them as cogs in the machine, if only to dispense with the battle for better terms. The consequence of giving in to coercion is that it never ends unless you exit that system.
Physicians can exert their influence in a health care environment to put the patient-physician relationship at the center of the enterprise. Working with middle-market employers (between 200-2,000 employees), some companies pair bold doctors with innovative employers to bring exceptional value to employee health benefits. There are no pre-authorizations for medical decisions, but doctors are held accountable for best practices. Customized health benefits offered within the ERISA framework allow employers to tailor programs and coverage to their employee population. A purpose-built tech solution allows all the players to see more, see it sooner, and maximize health. Nurses serve as the point of contact for employees and as trusted guides for any health concerns, facilitating appointments with doctors and other healthcare professionals. In this model, doctors are equal partners with employers, reducing avoidable costs while delivering higher quality care. Instead of a fragmented journey, patients are supported through three phases of care—navigation, facilitation, and resolution.
We have started a movement to restore the influence of physicians in decision-making that positively impacts patients, doctors, and employers. In the new model, “take it or leave it” is replaced with collaboration among all the players.
Paul Pender practiced clinical ophthalmology for 38 years, specializing in the medical and surgical treatment of eye diseases. He completed his residency at the world-renowned Wills Eye Hospital. His honors include a lecture series in his name by the New England Ophthalmological Society and the Secretariat Award from the American Academy of Ophthalmology for his work on webinars for clinicians.
Pender is passionate about patient-centered care. He believes that the patient-physician relationship should serve as the fundamental building block for health care reform. He is an advisor to Vxtra Health, a company committed to collaborating with physicians to earn trust and to reduce health care costs. By limiting the drain on health benefits budgets by intermediaries (health insurance companies, pharmacy benefits managers, and hospital systems), Vxtra Health establishes a path toward a new model of care, based on price transparency and fiduciary responsibility, starting with self-insured middle market employers.
He writes on timely medical issues on his website, his KevinMD author’s page, and other popular social media. He is the author of Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America (2020) and the ebook Standing Up and Speaking Out for Patients and Doctors: First Steps Toward Focused Health Care Solutions (2023).
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