"Bargaining" with HMOs

[Aggravated DocSurg](http://docsurg.blogspot.com/2005/03/bargaining-with-hmos.html)
>It has long been a tenet of modern medicine that physicians will simply have to accept ever declining reimbursement. For me, the bottom has been reached. While my group has occasionally cancelled or turned down bad contracts, in general the insurers came back with a more acceptable offer.
We are now faced with a new contract from UnitedHealth, which contains language so odious that we will be terminating 15% of our business to avoid signing. What, besides poor pay, can be so difficult to accept?
Problems like this will be the end of the independent practitioner of medicine as we know it within the next decade. Unfortunately it is an all too common indicator of what is happening with physician reimbursement across the board.
Soon doctors won’t be able to cover their overhead. When this happens their are only a few options.
1. Retire
2. Move to where reimbursement is better
3. Change professions
4. Change your type of practice
5. Become an employee
Unfortunately, I anticipate the last choice will become the most prevalent one. I envision that in the very near future most physicians will be the employees of some “Kaiser-like” system. They will have no responsibility to payroll, rent, utilities, malpractice or pension planning. They will take home a paycheck for a day’s work and have employer contributions to their 401K.
In short, physicians will cease to be small businessmen and women. When that happens, it will soon follow that they will cease to care or have any sort of feeling of responsibility towards making significant advances to their career. Longevity will be what is rewarded. Just punching a clock.
I’m sorry to say that I pity the future of health care in the United States. It will undergo a huge collapse before it gets better. It will get better, because fundamentally, those with the means believe they can pay for privilege. If the physician-employee doesn’t gain from this then it’s not likely to happen. For it to happen, people will have to start paying physicians directly for their services and not abstracted via third parties.
**When the public starts to understand that just because they have health insurance; it doesn’t mean that it pays for all of the costs of their health care.** If fact, [Aggravated DocSurg’s][1] problem is more universal as Medicare continues to decrease physician reimbursement and most PPO’s base reimbursement as a percentage of Medicare. It’s not just HMOs. In Southern California, I don’t have a single general surgical CPT code for any third party payor, except Workman’s Comp, that pays better than Medicare.
Me, I chose [option 4][2].
[1]: http://docsurg.blogspot.com/
[2]: http://fragensurgery.com/

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