Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

“Take it or leave it” is not negotiation but coercion

Paul Pender, MD
Policy
November 23, 2021
Share
Tweet
Share

“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 is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.

Image credit: Shutterstock.com

Prev

Should you stay or leave medicine? [PODCAST]

November 22, 2021 Kevin 0
…
Next

Bringing the Hippocratic Oath into the field of venture capital and entrepreneurship

November 23, 2021 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Should you stay or leave medicine? [PODCAST]
Next Post >
Bringing the Hippocratic Oath into the field of venture capital and entrepreneurship

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Paul Pender, MD

  • Why meaningful patient connections matter in medicine

    Paul Pender, MD
  • Global aspirations for value-based health care

    Paul Pender, MD
  • Employer health plans need a makeover

    Paul Pender, MD

Related Posts

  • Paid parental leave is long overdue

    Catherine Spaulding, MD
  • Physicians should never leave the lane of gun violence

    Linda Girgis, MD
  • Open enrollment: It’s time to leave your insurance plan behind

    Andy Schoonover
  • Doctors die. But the good ones leave a legacy.

    Jaime B. Gerber, MD
  • Why this physician teaches health policy in medical school

    Kenneth Lin, MD
  • The confusing policy surrounding the buprenorphine X-waiver

    Julie Craig, MD

More in Policy

  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • A surgeon’s late-night crisis reveals the cost confusion in health care

    Christine Ward, MD
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician
    • Hope is the lifeline: a deeper look into transplant care

      Judith Eguzoikpe, MD, MPH | Conditions
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • From hospital bed to harsh truths: a writer’s unexpected journey

      Raymond Abbott | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician
    • Hope is the lifeline: a deeper look into transplant care

      Judith Eguzoikpe, MD, MPH | Conditions
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • From hospital bed to harsh truths: a writer’s unexpected journey

      Raymond Abbott | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...