(WSJ) Most health plans are designed so their members pay more when they go to an out-of-network doctor or take a nonpreferred medication. But the financial sanctions -- which UnitedHealth has yet to impose -- mark the first time a physician could be fined by a health insurer if he or she directs a patient to seek out-of-network care or testing, the American Medical Association says.Is this where we're going to cut health care costs in America? Fine the doctor. As if we set the lab prices. Is the monopolization and WalMart-ization of health care always in the patient's best interest? Or could there just be, in the interest of corporate profits, an ulterior motive? I can just see UnitedHealth's Directors and Board Members sitting around the board room table:
The threats stem from a 10-year deal that UnitedHealth struck late last year with Laboratory Corp. of America Holdings to become its national in-network laboratory. With 28.5 million health-plan members and growing, UnitedHealth has been using its heft more and more in recent years to negotiate cut-rate fees with doctors, drug makers and other suppliers. In the same vein, it signed on Lab Corp. after its longtime lab partner, Quest Diagnostics Inc., said it couldn't accept new terms that UnitedHealth wanted and dropped out of contract negotiations.
To squeeze as much savings as possible out of the Lab Corp. deal, UnitedHealth sent a not-so-friendly reminder to doctors to play along. If doctors consistently failed to refer patients to Lab Corp. or other local in-network lab facilities as of March 1, UnitedHealth said it reserved the right to fine them $50, cut their fees or oust them from the network.
Hey Donna! I gotta idea how the heck we can pay for ol' McGuire's accountant fees and post-retirement corporate jet! We'll just tack on a fine to those pesky physicians! Imagine. 520,000 of 'em ordering way too many tests, say twenty a day, about five of which we can find as improper, times fifty bucks. Hell, that'd be a cool $130 mil! Yeeeeeee Haaaaaa! That'd pay for his jet with a little left over for us! Whatd'ya think, girl?"I love the double standard. Physicians can't refer to their labs due to concerns over conflicts of interest due to the Stark laws, but insurers can help themselves and do even one better: threaten physicians if they fail to make such a financially-motivated referral that lines the insurance company's coffers.
"Oh Steve, I love it when you talk dirty!"
Oh, but certain self-interested physicians don't seem to mind, especially those in leadership positions poised to profit:
Not all doctors are upset. The American Academy of Family Physicians wrote a letter of concern to UnitedHealth in February. But it told members that the health insurer had eased its worries after clarifying that it would not punish doctors for patient's decisions and only apply the sanctions in rare cases where a doctor repeatedly defied the policy. "This doesn't look as bad as it originally did," says Bruce Bagley, the academy's medical director for quality and improvement. Dr. Bagley also serves on a physician-advisory committee for UnitedHealth.I wonder how much they payed Dr. Bagley for his time to sit on their committee?