BLOG: Putting patients’ interests first solves a lot of problems

Read more from John A Hovanesian, MD, FACS.

Last week in Connecticut, a federal judge placed an injunction on United Healthcare hours before the insurance organization dropped thousands of doctors from its Medicare Advantage plans. UHC, after unilaterally altering its physician contracts without consenting with the contracted physicians, sought to drop about 2,200 participating physicians, according to an article recently published on healio.com/ophthalmology. Two separate medical societies in Connecticut successfully petitioned the court for this injunction in the interest of maintaining patients’ access to care and requiring the payer to modify its contracts “the right way.”

This story is not unique. Aggressive tactics to reduce provider panels have been undertaken by insurance companies across the U.S. and in many cases have been thwarted by physicians and medical societies showing that reducing the number of providers is not in the best interest of the health of the community.

Here is the scenario that is playing out across the country: Insurance companies, seeking to offer low-priced plans through state exchanges, are carving up their providers into smaller “narrow networks” of a limited number of physicians who provide care for a fixed group of patients at a reduced rate, often involving capitation. In exchange for accepting a lesser pay per service, these physicians are guaranteed access to a large pool of patients.

The problem, of course, is that a large number of patients are restricted to a small number of doctors — an access nightmare.

Physicians, facing the threat of being cut from contracts, and then having to sign new contracts with substantially lower fees (often 20% cuts or more), have to decide what to do. Most businesses simply can’t sustain a 20% loss in revenue and continue to provide a high level of service. The only answer is to say, “Find somebody else to work with.” The alternative is compromising what we do for our patients.

Health care reform has brought with it some nice advantages, like electronic communications and coordination of care between specialists (although these may take some time to be fully worked out). But as a society, we need to recognize that there’s a cost to the level of care our patients are used to and deserve. We, as physicians, have an obligation to maintain that level of quality, pushing back when necessary against tactics that are unrealistic. Our patients deserve it.