Saturday, June 5, 2010

Sunday Op Ed Piece - Is a Change Gonna Come?

On May 28th, the DOJ announced a proposed settlement with the Idaho Orthopaedic Society, a Sports Medicine Group, and five orthopaedic surgeons. The settlement prohibits the aforementioned groups from conspiring with competing physicians in the Boise, Idaho area, denying medical care to injured workers and in boycotting Blue Cross by terminating their contracts to obtain higher wages.

This so-called conspiracy is a mirror image of what transpires within the insurance industry on a daily basis. Gaining favorable fees is the equivalent of slashing reimbursements, and threatening to withdraw from healthcare plans is no different than denying covering to subscribers, its the yin and the yang of modern day medicine. Why shouldn't physicians be allowed to practice risk management they do it on a day-to-day basis practicing medicine? Running a medical practice is no different than running a company, it's a business. Fortunately, we haven't started to pay physicians with chickens, yet, but the time is coming. Isn't it ironic that insurance companies can share information by purchasing data based information via Ingenix to help other competitors establish reimbursements based on volume and demographics, but doctors cannot share information with one another? By sharing this information, insurance companies can accurately price risk based on actuarial experience.

As federal and state governments continue to pander to big business by filing civil antitrust lawsuits against physician groups that coalesce to influence their reimbursements, once again the question must be asked, isn't it time to repeal the McCarron-Ferguson Act of 1945?

The McCarron-Ferguson Act is a federal law that exempts the business of insurance from most federal regulations, including federal anti-trust laws. To qualify for this exemption, each state had to engage in oversight. By allowing states to regulate the insurance industry without federal oversight only exacerbates the amount of graft and collusion that exists between state banking and insurance commissions, no different than the federal government. In addition, McCarron-Ferguson creates a safety zone for insurance companies to share information without worrying about private antitrust exposure. Selling insurance across state lines could potentially raise questions about greater federal involvement when one becomes engaged in interstate commerce. Its time to face reality that the current healthcare system and programs like workers comp and Medicare are in need of a serious facelift.

The formulas that have been used to reimburse physicians have outlived their time, meaning its outdated, and contains many flaws. What was good then doesn't necessarily mean that it is good now. But what can Americans expect when we are adverse to change, and when our own government specializes in band-aid solutions regardless whether it was Bush or Obama. A solution that is predicated on preserving ones poll numbers and special interests does not work in modern day healthcare. The system has used up its "get out of jail" cards by performing patch work carpentry and then letting the next guy have to worry about it. The system as we all once knew it is broke and in desperate need of reconstruction. TSB wants to know what our readers think.....

"I was born by the river in a little tent, Oh and just like the river I've been running ever since, it's been a long, long time coming but I know a change gonna come, oh yes it will"


  1. Lower reimbursement payments from insurance companies means lower reimbursement payments from the government run healthcare programs (Medicare / Medicaid). It isn't fair, but the government will always support it's own interests before it supports the interests of physicians.

  2. The government (politicians) will always support those who help get them elected or re-elected. The largest support groups on both side of the fence for campaign finance are insurance organizations.
    Until this changes, the physicians will always be the low hanging fruit suceptible to reimbursement cuts.

  3. how many anti trust laws has the tsb violated?