Is It Time To Switch The Dial On Insurance Networks?

Stephen Barrett DPM FACFAS

I know this may “date me” a bit but I remember when network TV was the pinnacle of entertainment. Networks delivered high quality products that were substantive and complete. We were happy with it. There were few channels but great programming. Even as new channels were introduced, network TV was still the place to be. After all, billions of dollars in advertising money can’t be wrong, right?

Alas, over time, there has been a slow degradation of the product. This has been so insidious in fact that the average viewer never realized (and still doesn’t) that what happened was occurring right in front of them. For example, the network that gave us J.R. Ewing now gives us a lineup full of a bunch of some reality crap, including a show about a bunch of people on an island trying to survive but in which no one really dies. How is this reality?

Here is the secret. This tripe costs much less to produce and is an exponentially inferior product to scripted shows. However, it still has the sleepwalkers (substitute viewer or “provider” if you desire) captivated because they have seduced you for so long, they can just keep beating you up. The same amount of advertising dollars or more pours in, but with less expense and effort in production. This sure makes the investors and shareholders proud.

Sounds like big medical insurance companies, doesn’t it? Take more from the insured and pay the provider less, and both end up with an inferior product.

I must admit that I was only recently “enlightened” myself. In a rare down moment, for a chance for mindless (what I thought would be) fun entertainment, I tuned into the reliable old network and trusted it would deliver. But hold on … a few seemingly endless minutes of some insipid 20-something whining about — well, who cares — and then her blond head morphed on the screen and a perfectly coiffed gentleman emerged. As I watched in horror, his CEO lips started to move into an evil grin.

“Sign it, you pathetic bastard. You know we are the only game in town,” he said with his tone of disdain and superiority. An image flashed on the screen. It simply said: 99203 - $91.80.

I bolted upright, the cobwebs scattering from my brain. Really? He wanted me to sign a contract with these rates for the “privilege” of staying with his network, a “preferred” provider. We all know that it takes close to an hour of time for a real 99203 new patient office visit to occur with any degree of thoroughness.

I snapped back at Mr. CEO, “No way. I’m not going to take this anymore.” (I hope you hear the epic song from Twisted Sister resonating in your head right now.) Getting closer to screen, I yelled, “I can switch you off right now. I don’t have to stay in this network.”

The coiffed one fired back, “If you change my channel, you could end up watching a blank screen.”

So my fellow colleagues, I want to tell you a little bit about this horror movie, which will justify why I had to finally grab the dial (no remotes—old real tube TV) and switch from the “network” show. I really wanted to throw a brick through the screen but then I would have probably been forced to attend “anger management” in this ridiculous politically correct world.

By staying “tuned in” to this channel, you are nothing more than a slave, maybe at best an indentured servant of Mr. CEO. He loves keeping you, telling you each year he is going to give you less than the year before because he “needs a little more.” This guy is a modern day double agent Robin Hood stealing from those “rich” doctors while nonetheless demonizing them to the other group he is stealing blind: the insured who pay their premium every month to receive less in benefits.

A Closer Look At How Much DPMs Are Worth And How Many Expenses They Have

Now I know the majority will say, “But I have to stay on the ‘channel’ because I’m too scared to change it and I can’t afford cable.” Okay, so you are worth $100 per hour gross? (You probably have at least two staff people who make a third of that.) How about this: journeymen and master plumbers can make up to $110,000 per year.1 If you do the math, and as we all know liars figure and figures lie, but that is about $55 per hour, assuming a 50-week per year, 40 hours per week work schedule.

Now when you factor in the fact that plumbers have no malpractice insurance, no significant overhead like ultrasounds, radiographic equipment, electronic medical records fees, multiple staff, a physical plant — and yes, they probably don’t have $250,000 or more in escalating student loans to pay off — who is really making more money?

I want to make it perfectly clear that I am not beating up on plumbers. I like them and we all need them. Tell me they are not holding more esteem in your heart than any neurosurgeon when the bowl is backed up and starting to overflow in your newly carpeted bathroom. Most of the time you need a neurosurgeon, you are not cognizant enough to know it. You decide.

Here are some facts that maybe will jolt you out of your professional sleepwalking and unwillingness to change the channel:

• Patricia Hemmingway Hill, the CEO of Blue Cross and Blue Shield of Illinois, made on top of her base $1.1 million salary a bonus of $16 million.2

• Since 1995, the cost of living has escalated almost 20 percent while surgical fees have decreased by nearly 30 percent.3

• The costs of medical malpractice insurance have generally increased over the last decade, which is the opposite of professional surgeon fees, which have declined as stated above. This can vary from state to state but you get the message.4

Your office staff salaries have not declined over the last decade. Your rent has not declined over the last decade either. (If it has, call me. I want to meet your real estate guy.) Costs of medical supplies have certainly not decreased over this period of time. The cost of medical education has escalated to the point where it is not unusual for students to finish the four years of podiatry school with greater than $300,000 in debt with an interest rate around 6 percent.

I can go on and on, but if that doesn’t wake you up, then all the other facts will somehow pass by you without notice anyway.

Final Notes

How did we get to this pathetic place? We got comfortable, we trusted a little too much and now the challenge of the journey into the unknown seems a lot scarier and worse than just letting insurance companies abuse us.

Well, I say it’s time to proclaim, “We’re not going to take it anymore!” All health professionals have been severely demonized as “greedy” by the insurance company plot. They disseminate this propaganda to the poor insured patients, putting a wedge between provider and patient.

Who’s greedy? Look at these stats for the big four, for revenues and percentage increase from 2010.5 United Health Care made $101,862 million (8.2 percent increase), Aetna made $33,779 million (1.4 percent decrease), Humana made $36,832 million (8.8 percent increase) and Cigna made $21,998 million (3.5 percent increase). Looks like the networks made a lot of money and poor old Aetna actually had a decrease from 2010, but still had a net profit of $1.9 billion.

If that hasn’t riled you up a little, my fellow “greedy” doctor, then take a look at all the slick CEOs’ salaries. I am switching the dial right now.

Sure, it takes a little effort to find the “something” better that’s out there. It might be a little bumpy at first, it might take a little time and if you can’t think past the next 30 days, then I guess go ahead and stay where you are. However, I plan to spend at least a few more years doing what I was trained and love to do – helping patients – and I’m not going to go broke doing it. The land of milk and honey awaits us.

References

1. Available at http://everydaylife.globalpost.com/typical-income-master-plumber-11449.html . Accessed Nov. 8, 2013.

2. Available at http://www.chicagobusiness.com/article/20130411/NEWS03/130419970?templat... . Published April 11, 2013. Accessed Nov. 8, 2013.

3. Available at http://www.ethicalhealthpartnerships.org/reimbursepictures.html . Accessed Nov. 8, 2013.

4. Available at http://www.ehow.com/about_5514154_average-cost-medical-malpractice-insur... . Accessed Nov. 8, 2013.

5. Available at http://money.cnn.com/magazines/fortune/fortune500/2012/industries/223/ . Published May 21, 2012. Accessed Nov. 8, 2013.

Comments

It's time for a national physicians union. Put simply, if we are forced to take insurance (private or federal) under the new ACA, then we must have a unified voice.

I would offer that the first order of business is to simply opt out of all insurance. We accept all patients, offer upfront pricing, allow the patient options and choices, and practice medicine! The patients can go back to their insurance companies or the federal government, and wait for reimbursement. We cannot allow our profession and lives to be dictated to us.

Absolutely agree Mark!

The problem is that, just as we found with the capitated insurance plans, there will always be someone who WILL take the lowest fee just to undercut everyone else and get the exclusive contracts. We are our worst enemies in that regard.

I would love a physician's union but it would have to be run by physicians and not desk jockeys. With a legitimate union in place, we would not have to worry about collusion laws, and could have a strong voice on Capitol Hill.

Sadly, to get a bunch of physicians to agree on just about anything as a one voiced whole is a "Forest for the Trees" situation. Even amongst the new crop who are struggling to make ends meet and pay back their student loans.

How much would it cost to set up a union and who would pay for it?

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