Insurance Co's - Enemy or Ally

Insurance companies can raise the ire of almost any Physical Therapist just by the thought of them, let alone an interaction with one.  This perspective that we have of them and the one they have of us, may simply be a lack of understanding by both sides that we in fact should be allies of each other not enemies or necessary evils.  Could it be that the positions we have each taken in solving the healthcare issues we are faced with are inherently incompatible (lower reimbursement versus higher or respectable reimbursement)?  The predetermined solutions they have come up with are an independent effort to get their interests met.  The current paradigm is that we don't pro actively help them reach or achieve their interests.  An assumption is made that our interest must be incompatible.  I believe the opposite is true!

If we step back and look at the motivators behind why the insurance companies have chosen their positions or solutions (less reimbursement, restricted visits, increased paperwork, middle managers - ACN's of the world) to the issues in general within our profession, it is possible to understand why they have chosen the positions or solutions they have.  First lets identify their motivators:  I believe they are to reduce over utilization, reduce costs, improve outcomes and improve their bottom line.  What are our motivators (as EBP outpatient practitioners)?  How about better outcomes, proper utilization, improved access to more acute conditions, and improved bottom lines.  Are these motivators (also called interests) incompatible?  Or are they different, similar and/or compatible?  Maybe we are seeing things only from each others positions instead of ours/their interests or motivators?  What would happen if we got on the same side of the problem and found different solutions that met all our interests?  Can we meet their interests and our interests at the same time?  I think if you understand EBP and its capabilities to affect change in line with the interests of both parties, you can see more hope.  We need to change the dance steps - shift the paradigm - by opening their eyes to the common and compatible motivators that we share.  Think about how the WSJ article is a microcosm of how our interests can be compatible with theirs!! 

Thoughts and comments?

- Jeff

Comments

[Rob Wainner]

Jeff,

Great post and thanks for throwing out a different paradigm for us to consider.

Stephen Covey has said that in his consulting work involving conflict resolution that about 95% of the problem is generally due to unrealistic or unmet expectations or miscommunication or a lack thereof. Could this be part of the problem? Perhaps part, but it is now compounded by money and greed on the part of insurers who make obscene profits at he expense of other (which is the key....i am all about the free market but it has to be responsible capitalism). Obscene is defined not such much as the final $$'s , but the fact that that final $$ number is being generated at the expense of the employers, patients, and society in general.

Let's engage these folks with interest based vs position based negotiating and see if that might be one part of helping turn this disaster-in-progress around.

Rob

[Kerrie]

Great comments Jeff. I think they are right on target. It seems that maybe it is time to lay down our swords and look for a joint solution to our common problem. In the end, we all get something out of the deal with the greatest benefactor being the patient; better care at lower costs.

[Damien Howell MS, PT, OCS]

The questions you raise are very stimulating. The view of negotiating with health insurance companies for a win win result is a bit of a over simplification. Negotiations need to include patients and employers. How do we get it started?

Damien

[Eric]

This is utopia. I used to think this way, but the insurance companies are not out to work with you or me. How many of you have gotten a raise for following their guidelines or rules/regulations, for practicing EBM? I have found in my 15 years of practice that the co-pays, and deductables have increased, with reimbursement rates decreased. Patient's are paying more out of their pockets and pay checks for benefits that used to be a perks. Now, insurance companies are reducing how many visits, what can be performed, and how much we charge because they hold all the cards/money. There are always gonna be doctors and therapists that will accept the meager reimbursement rates. So we see more patient's for less money and at more risk. Although our cost of business has increased, their preferred providers take reimbursement hits year after year. Their premium rates increase dramatically every year sometimes even by the quarter. Their deductables increase, copays increase and percentages increase. But their overhead has decreased. Have you looked at your charts/files lately and see how much paperwork is true patient information and how much is insurance related paper. We have charts that are 3/4 full of insurance junk and the rest is patient medical information. Now the insurance companies want us to use everything paperless which will benefit them not us. Where is the checks/balances. They are attempting to get the levage to put money into our accounts which sounds great but they also have the right to take money away if they feel/believe they have over paid us. How many of our offices/clinics would reduce its over head significantly if we did not have to have insurance verification, billing, collections, or reviewing their interpretation of the codes we bill for and what is to be bundled and what is global. Thats why insurance companies are diversied now and not just insurance companies. Sorry, your thoughts are utopia that will not ever work. Eric.

[Larry Benz]

Eric raises some realistic points. Talk is cheap even in the situations where they claim to be concerned about quality and outcomes at the end of the day it is about lowering their cost.

I do believe that what everyone is after is consistency and much less variation which is what we are all about in EBP locations.

[Jeff Hathaway]

I appreciate everyone's feedback! I must first state that I am not naive enough to think this would be an easy proposition and I realize that some insurers have no interest initially to work with us. I do beleive that there are some that would. I agree that including employers and patients is a critical part of the process. If we don't meet the interests of the patients then it cannot possibly be a true win-win.

Eric, with all due respect, I have seen this process work in situations where the two sides seem to have no hope of collaborating. I have also seen that staying in a victims role yields no chance of progress. Are there injustices and are there major obstacles? - absolutely!! But staying status quo is not for me and I beleive that we collectively we have the intelligence, determination and creativity to start to turn the tide one small insurer/employer at a time. We have to trust the process will reveal the answers.

I beleive action, especially positive action, will lead to things we cannot even imagine or foresee right now! I am open to alternatives but I am not going to play the victim or fight others when I beleive there are better more productive ways. I am ready to take the "abuse" necessary to facilitate change. - Jeff

[eric]

I agree Jeff. Thanks for intelligent conversation.

[Eric]

Did anyone catch the Anderson Cooper 360 report last night on the insurnace companies game plan. Just wanting to see what you all think after hearing that interview. Jeff have your thoughts changed any?

[Jeff Hathaway]

Eric - Had to TiVo it until I get back home Thursday. I am sure it at least verifies the difficulty and size of the mountain in front of us - I will comment after I see it though! - Jeff

[wqbkzpxizf]

sex in the city carries laptop