Physicians and Insurers: Can They Get Along?

Carol Peckham


October 21, 2014

In This Article

Is It All Bleak?

When physicians were asked to provide written advice about dealing with insurers, many of their responses were strong and negative. Twenty-two percent of the comments urged physicians to be assertive and oppositional ("fight," "be tough," "lawyer up," "opt out," "organize," "join physician groups"), and 8% either expressed despair or suggested leaving altogether ("retire," "quit," "hopeless," "all bad," "pray," "scream"). Nearly 10% advocated a cash-only or concierge business. Only about 2% advocated kicking out government payers altogether, and the same percentage focused on kicking out specific private insurers.

There were some measured responses. About 21% had general advice on dealing with insurers (eg, "be informed," "document," "persist," "appeal denials") and nearly 10% recommended having a good billing staff or going to outside sources for help.

Despite physician pessimism, Judy Aburmishan saw some hope when looking toward the future. "A lot of the forces that are going on today are good but it's going to be chaotic before it gets better. Once we get over the current unrest, I see some beneficial trends toward a better and more direct relationship between the doctor and the patient.

"Concierge and cash-only practices and marketplace exchanges with higher deductibles will make patients responsible for at least part of their care," she said. "And when patients have to make their own treatment decisions, physicians can be less worried about malpractice suits. Furthermore, the baby boomer physicians will be retiring. They have been running cottage industries and have been resistant to EHRs and the changes in the way they need to manage their practices. Younger doctors are more comfortable with large organizations and with technology. They are joining together and understand that by forming groups and hiring good businesspeople, they can provide cost-effective care. With the establishment of electronic records, they can also be more proactive in following up with patients."


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