Managed Care and Docs

Edition: November 2002 - Vol 10 Number 11
Article#: 1343
Author: Repertoire

If there ever was a contentious relationship, it is that between managed care companies and physicians. Here’s what William Jessee, M.D., who is president of the Medical Group Management Association, had to say about it during a recent conversation with Repertoire.

For a number of years, managed care plans treated physicians like they were interchangeable parts. I don’t think they’re able to do that anymore. To some extent, the balance of power has shifted in the marketplace. The plans managed to make enemies of their customers, the patients and the physicians they depended on to provide services. They had no friends left. Now they’re trying to be a bit more conciliatory. And physicians are also learning that they have more negotiating leverage than they did….For a [managed care] plan to lose a group of eight or nine general surgeons can make the plan much less marketable.

Still, there’s a lot of frustration among our members [i.e., medical group practices] that the plans tend to compete on things that just add hassles for the providers and don’t do much in the way of differentiating them in the eyes of the consumer. For example, why do health plans all have different approaches to credentialing their physicians? If one plan verifies that you went to medical school, why don’t the other 11 accept that? And why do clinical guidelines for doing procedures vary from plan to plan? Shouldn’t that be based on science and not proprietary guidelines? The plans have increased their administrative costs. It’s one step to realize that, it’s another to solve it.