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Managed care insurers buying up physician practices

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http://www.washingtonpost.com/insurers-quietly-gaining-control-of-doctors-covered-by-companies-plans/2011/06/29/AG5DNftH_story.html?wprss=rss_business

 

"Even if UnitedHealth Group isn?t your insurance company, there?s a good chance it touches you in some way. The $100 billion behemoth sells technology to hospitals and other insurers, distributes drugs, manages clinical trials and offers continuing medical education, among other things, through the growing web of firms it owns.

 

Now, that touch could get a lot more personal. United health services wing is quietly gaining control of doctors who treat patients covered by United plans ? buying medical groups and launching physician management companies, for example.

 

It?s the latest sign that the barrier between companies that provide health coverage and those that provide care is crumbling.

 

Other large insurers, including Humana and WellPoint, have announced deals involving doctors in recent months, part of a strategy to curb rising health costs that could cut into profits and to weather changes to their business arising from the federal health law. But United is the biggest insurer by revenue, making the trend much more significant.

Many patients insured by these companies are going to see much tighter management of their care."

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This is Beth, justme's partner. I'm very concerned about this merger between health care and health insurance. I'm a psychologist, so I see this from both our end as consumers and my end as a provider. We also live near Pittsburgh, where Highmark BC/BS is starting to compete with the University of Pgh Medical system, joining them in merging health care and health insurance. I am very concerned that those two systems are starting to divvy up the Pittsburgh population for who can provide medical treatment to whom. If the best place to get a particular surgery is at West Penn Hospital, I want us to be able to go there for it. If the best Cushings doc is through the UPMC system, all Pittsburghers with Cushings should be able to get to him/her. There are increasingly physician offices that I can only send some of my clients to, because they are so in bed with one insurance system that they aren't allowed to take the competing insurance system. In return, one practice has just gotten to greatly expand their building, equipment, and scope of practice, and they have now become the primary primary care physicians for a particular nearby hospital. We tried this before. In the 1980's the health insurance systems invented "capitaton," a system by which physicians got a certain amount of reimbursement for treating a person, regardless of how much treatment that person needed -- this "incentivized" them to undertreat -- my primary care physician in the late 80s once refused to treat the chronic pain I had in my navel on the basis that "such pain couldn't physiologically exist." I had to quit another PCP who got "managedcaritis" after having been a very good doctor for years. I was kicked off a managed care company's provider list at one point because my average length of treatment was longer than they wanted -- they said so directly, first telling me I would be kicked off if my average did not fall to about 6 sessions per client, then kicking me off after I got it to that point because it should have been three sessions per client. The fact that I bowed to pressure to reduce the length of treatment at all means that they were impacting my judgement in giving clients what they needed. At about the same time, my mother was one of several people being treated in the hospital for a deadly disease -- she was the only one offered a particular experimental treatment, probably because of decisions made by each insurance company about what they would and wouldn't cover (Mom had a "cadillac" policy at the time) -- as she got better, she was asked to spread hope by visiting one of the other patients with the same disease, but to not discuss the experimental treatment -- Mom lived, the other lady didn't, and Mom felt horrible survivor guilt about how she was offered a treatment not available to all patients with the same disease. This trend is especially important to people with little-known medical problems like Cushings, which is already underdiagnosed, repeatedly blown off, and requires a doc to fish around doing testing to find. Mangedcaritis will mean an even longer time between symptom onset and treatment for Cushings folks, more folks who get no treatment because they give up trying to get help after repeated attempts. We all need to be aware of what it means when insurance companies dictate our medical care, and we need to scream bloody murder when they try to get more power -- because that's what it will become, murder via conspiracy to save $, when more people don't get necessary treatment because the physicians are trying to hard to do the insurance company's will. Please consider contacting your legislators and doing whatever else you can to stop this trend. Thanks for letting me rant.

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Everything you've described is the nightmare I expect to spread like wildfire. Rather than have non profit gov't run insurance limiting choices and access, we will have for profits, pulling shareholder dividends and HYOOGE employee and excecutive salaries out of the health care system.

 

This is what you get when the fight for government run health care falsely leads people to think the private marketplace will have more freedoms.

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I worked for CIGNA for nearly 30 years prior to retiring. Their Phoenix set up has been in existence for more than a decade (probably 2 decades) and is not a new situation. It appears to have worked well for those in Phoenix.

 

As for the United, it's interesting what they are doing. As with most things in life, there will be positives and negatives. The insurance industry is heavily regulated by each state and they will not be able to operate outside of those regulations. If there are problems reported in the 'quality' of care, the legal system can be invoked to take care of them.

 

I wrote in another post the other day that if I had been in an HMO, I would not have been diagnosed. That is my greatest concern when I see items such as this.

 

To me, this is going to be a watch and wait situation --- it will get large media attention if there are problems.

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I was kicked off a managed care company's provider list at one point because my average length of treatment was longer than they wanted -- they said so directly, first telling me I would be kicked off if my average did not fall to about 6 sessions per client, then kicking me off after I got it to that point because it should have been three sessions per client.

 

I am a pharmacist and I have always suspected this but never heard a doctor in managed care admit to it.

 

murder via conspiracy to save $, when more people don't get necessary treatment because the physicians are trying to hard to do the insurance company's will.

 

So awful but true :(

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Yes, this is why I wish they had passed a single-payer system (i.e. expanded Medicaid/Medicare to all), like there is in Europe and Canada. I've had to fight with even good insurance plans for basic coverage, let alone the expensive things. I'm sure many of you have had similar experiences.

 

When I was 19, my mom had to argue at length to get our insurance to cover my birth control pills, because they were medically necessary (I was getting about 4-6 periods per year, and the gyno was concerned about my long-term fertility). My husband had an ingrown toenail not covered because it was considered "surgery" even though it took 10 minutes to treat.

 

When my husband started seeing an Endo, he had a limited benefit plan from Cigna (it was the only thing his company offered, even to their managers, and my school wouldn't allow spouses on the student plan). So Cigna first argued that the blood tests were unnecessary, then said that it was a pre-existing condition (it wasn't). Cigna managed to delay paying anything for 6 months and required many letters and phone calls to get anything covered, and we ended up owing $2000 out of pocket. To top it off, his employer asked for everyone to fill out health insurance forms because they were switching plans and to send the forms to HR. He put down the hypothyroidism and pituitary disease (that was a mistake). He was fired in under a week for very flimsy reasons, only a few months after being promoted. We should have sued them for wrongful termination, but we couldn't afford a lawyer, it would have been difficult to prove anything, and I'm sure they had already destroyed the evidence.

 

Even our current "cadillac" plan (although it is an HMO) has had their fingers in many medical decisions, like whether he needed a MRI, and then where he could go to get it (I wonder if they picked a cheap place that never finds anything wrong). And apparently we can see most doctors in our city, but we couldn't travel to another city for surgery, which would be wonderful in the case of pituitary surgery.

 

So, it is hard to believe that the government could possibly be any worse than private insurance companies. Also, maybe this sort of thing is really why it is so difficult to convince some doctors to test for Cushing's.

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The truth is that government and for profit health plan managers will interfere in the coverage and treatment process, but that Canada, for instance, employs/pays hundreds fewer employees per 1000 patients than U.S. profit making insurers do, and no shareholders or billionaire executives with dollars that should go to treatment.

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