fbpx

Doctors Need to Better Understand the Complexities of Healthcare

Anish Koka, MD suggests doctors should pause before reflexively focusing on the wrong issues that they think need change in healthcare.

May 17, 2024

Doctors need to resist the reflexive desire to reach for first order solutions.

Some examples :

 

1. Ban prior authorizations

I hate prior authorizations as much as the next doctor, but if I ran an insurance company, would I just blindly pay for every test/procedure ordered by my colleagues?

Health care is already incredibly expensive in the US without some rule that would essentially pass on costs via premiums to consumers.

 

I hate prior authorizations as much as the next doctor, but if I ran an insurance company, would I just blindly pay for every test/procedure ordered by my colleagues?

 

2. Ban PBMs

PBMs are constructs that naturally arise in the system we have created.

Buyers and Sellers are always trying to gain an advantage when negotiating prices.

If a group of physicians seek to form a group so they can get better prices on ECG paper, is that wrong?

Should some economist at Yale (while on break occupying the quad for the latest thing) then formulate what percentage of those savings be passed on to the consumer?

 

3. Ban non-competes

What other parts of contract negotiations should we disallow based on some panel of 3 bureaucrats in government ?

Banking non competes means that hospitals that get paid 3x for the same services can poach physicians from private practices.

Why should private practices hire medical trainees, when they can still expand using mid levels that are less of a threat to the practice if they leave ?

 

(advertisement)
We invited lawyer Kyle Claussen to help us better understand the new FTC ruling on :non-competes”, in an episode of our SERIES, SoMeDocs Conversations.

 

Physicians need to coalesce around a framework that doesn’t violate the reasons is the best place in the world to live and work.

Our healthcare problems are a result of massive over regulation which is the basis for the big hospital-big insurance cartels that are bad for patients and physicians.

The appropriate action to take is to lift the heavy finger of government off the scale — focus on legislation that preserves the power of these cartels.

 

In the provider space:

1. Get rid of certificate of need laws that prevent competition to hospitals.

2. Get rid of the 340b program that is completely mismanaged to the benefit of hospitals and not patients

3. Get rid of the reimbursement differences between private practice and hospital owned physicians

4. End regulations that force low risk procedures to be be done at quaternary care hospitals

5. Get rid of HIPAA – it just adds friction that makes healthcare less portable and more expensive. It also mandates an outdated form of communication for health care entities that then gives clearing houses a reason to exist in their current form.

The list could go on and on, but unless physicians understand the complexity and have a clear idea of what the North Star in healthcare looks like, we just serve as political pawns for both parties who are in turn proxies for the big cartels (hospitals and insurance companies).

So if you’re liking some tweet that wants to ban PBM, there’s a pharma lobbyist that’s gleefully rubbing their hands when you do!

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

Share

7 Responses

  1. I am 92 years old and retired from practice several months ago. I was in private practice since 1968 and watched the slow and painful demise of the “private practice ” of medicine over the years. It is my opinion that the AMA was never a proponent of the private practitioner because each time I had correspondence or one to one conversatuions with our local rep, the responses invariably was “we will look into it”. As the inroads were made by medicare etc., very effective scare tactics eroded private medicine. Instead of championing our status the AMA joined forces with first LBJ then Hillarycare to further the slide to “corporate” medicine where we find ouselves today.
    My post graduate training was at a county hospital and it is my sense that the people who needed care were accommodated with some delay at times, but I do not believe care was DENIED as I feel it is in some instances today.

  2. I agree with you. The 50% or so extra that hospital owned physicians get as a “utization” is a travesty and private doctors with our huge overhead need this.
    HIPAA I agree is an outdated concept. If large insurance companies like United Healthcare can get hacked and not be fined then it creates a hypocrisy as providers are not spared that clemency.

  3. Wouldn’t ban 340B entirely. Apparently 340B has been misused by hospitals. In the outpatient world it provides lifesaving drugs to un- and under-insured patients.

  4. Excellent piece but leaves some things out of the conversation. For instance, the conversation about prior authorizations is framed the wrong way. I would not care less about prior authorizations, i would ask the patient to deal with this. Non contractual obligations release you from the tyranny of Insurance Companies. Do car repair shops have CONTRACTS that the repair guy has to have a back office that negotiates the price of the repair, a fully staffed Finance office etc. that ALSO increase the price of health care services? And for my Colleagues who enquire about weather I would pay for any bill submitted, the solution existed and was an old one. Provided patient paid 20% of the charged cost, the insurance would not need any Pre-Auth office. And by the way, Do Not Compete clauses have no legal basis in intellectual Property as the Physician is not granted his MD by a Practice but comes to the practice with it; It is a blackmail tool that really should be banned. In my humble opinion, the sorry state of affairs that modern Medicine has become will be very difficult to reverse as there are too many interests that lobby for every principal group, Private Capital, Hospitals Academic Centers Pharmaceutical Companies etc EXCEPT Physicians,

  5. Physicians are not good at this stuff. Anish I am glad you care but you need to do more homework. PBMs do not lower costs they increase costs. The EKG paper would be purchased by way of a Group Purchasing Organization (GPO) contract not a PBM contract. Uniquely the PBMs and GPOs are monopsonies within the supply chain. The three PBMs control 85% of all prescription drug costs and the four GPOs 85% of all hospital purchasing contracts. Uniquely these seven companies have an anti-kickback safe harbor. They are allowed to write pay to play contracts and they do. That is the problem. The FTC is right on this after permitting this arrangement for so long. Here is the best primer on the issue. Four minutes of truth. https://physiciansforreform.org/no-middlemen

Leave a Reply

Your email address will not be published. Required fields are marked *

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Of Interest

Subscribe To Our Newsletter

Get updates and learn from the best

Side Ventures [SERIES]

Side Ventures [SERIES]

Coming Soon: Guests will discuss the side ventures they’ve taken on, from the books they’re writing, to the podcasts they host, to other extracurriculars they’ve taken on.

Want More?

Be a part of our healthcare revolution. Don't miss a thing SoMeDocs publishes!

Disclaimer: SoMeDocs assumes no responsibility for the accuracy, claims, or content of the individual experts' profiles, contributions and courses. Details within posts cannot be verified. This site does not represent medical advice and you should always consult with your private physician before taking on anything you read online. See SoMeDocs' Terms of Use for more information.

follow us

© 2024 SoMeDocs. All Rights Reserved.

Soak up content & grow

Educational reflections..

Drop your email address below and we’ll email you the link for continuing opportunity pathways from CMEfy. Check your spam folder if you do not receive our email. We’ll also add you to our Sunday newsletter, so you can receive even more of our unique content!

Support A Platform that Celebrates Real Doctors

For as little as $10, you can help keep this openly accessible site available to all & help us sponsor in more doctors.

Interested in subscribing
to our unique content?

Interested in subscribing to our unique content?

Play Video
Our Founder Answers Your BURNING Question

SoMeDocs

“Why should I become a member of SoMeDocs if I already have my own space online?”

Site SoMeDocs Logo, square

WANT TO STAY IN THE LOOP?

DON'T MISS A SINGLE CONTENT PIECE.