Brian Klepper
In today's New York Times, Elizabeth Rosenthal describes the growing and egregious over-treatment and overpricing practices by physicians and health systems, abetted by health plans.
The excesses detailed in this article are at the core of our national health care quality and cost crisis. The best solutions are collaborative, considered actions by group purchasers, potentially the most empowered of health care's stakeholders.
When predatory anecdotes like these come to light, the benefits managers - or better yet, the CFOs - of local employers, unions and governmental agencies should immediately call the health plan and demand that the health systems, physicians and other providers involved be removed from the provider panel. (Small communities held hostage by a few dominant health care players are a separate topic that I'll address soon.)
As Tom Emerick, former VP Human Resources at Walmart has stated repeatedly, health care will not improve until purchasers demand different behaviors from health care vendors, focusing business on organizations that facilitate high quality care at reasonable cost, and publicly avoiding those that do not.
This is a serious issue that demands a coordinated response. It is at the top of NBCH's agenda. Join with us on this.
News from the National Alliance, member coalitions, partners, and industry to help drive quality and value of healthcare services.
I see more and more employers and other purchasers at the table to demand the right care at the right price. NBCH and your member coalitions are truly making gains, and I commend you.
ReplyDeleteUnfortunately, the more one looks, the more they see of this type of activity in today's money-driven healthcare system. This is not a one-off problem. As Jonathan Skinner pointed out, "cowboy doctors" are a $500 billion a year problem.
ReplyDeleteThe problem is that these doctors are already not part of the insurance provider panel. As independent entities, they are not bound by the contract that a participating provider agrees to and, as independent business, able to charge whatever the market will bear and have a legal right to collect their fees. The problem is not only among doctors, but hospitals, emergency care facilities, and urgent care facilities have also used this tactic to reap undeserved income.
ReplyDeleteThe problem is that the patient is seldom informed of the potential fee or that a doctor, not of their choosing, is involved in their care and they will incur unexpected costs.
A few states have imposed limits on the amount a nonparticipating physician or facility can charge, but that does not completely resolve the problem.