Partnership Problems

One of the essential factors in managing your health care and its costs, and certainly if an appeal is required, is forging a meaningful relationship with your physician. The pressures they increasingly face from the demands of the “Medical Industrial Complex,” combined with the bureaucratic mentality of insurance carriers, however, makes this increasingly untenable.

A recent article in the New York Times (“The Moral Crisis of America’s Doctors,” 6/15/23) highlights the increasing difficulties doctors face before these twin pressures. While the intransigence of the carriers and plan administrators is a given here, new demands for efficiency and cost reduction (read as less time with patients, withholding treatment or basic denial of “due medical process”) by the dominant financial players in the health care delivery market have compromised doctors to such an extent that an increasing number are burning out or burning their bridges by quitting medical practice altogether. “Our survey found that nearly one in five health care workers had quit their job since the start of the pandemic and that an additional 31% had considered leaving.”

This at a time when doctors are treated more like employees rather than respected professionals, when “70% of doctors work as salaried employees of large hospital systems or corporate entities,” which, in turn, are said, correctly, to value “profits over patients” and lay out performance metrics called “Relative Value Units” (RVUs). Hospitals are closing less profitable sectors of their business (e.g. pediatric units and Skilled Nursing Facilities) and focusing on acute care. Doctors and nurses are increasingly characterized as suffering from “moral injury” (the intense psychological clash between ethics and “the realities of making a profit from people at their sickest and most vulnerable,” according to psychiatrist Wendy Dean). Doctors can’t talk on the record due to non-disclosure agreements, are “threatened for raising quality of care concerns, and pressured to make decisions based on financial considerations.”

Fight or flight? While more healthcare professionals are fleeing, some are fighting back. Unions are forming and there is a pending suit in the California courts by the American Academy of Emergency Medical Physicians Group against Envision Health Care, a private equity-backed provider, accusing Envision of violating a California statute that prohibits non-medical corporations from controlling the delivery of health services.”

While the battle rages and more health care is delegated to third-party controls, this creates enormous difficulties for doctors to work with their patients on directing care, prescribing drugs, determining appropriate service delivery, and interacting with carriers and administrators to ensure smooth claims handling and potential appeals. Patients should be aware of the greater time constraints put on their partners, and the additional time that will mean for filing claims, follow-up and discussion with third parties who want to cut care rather than support it.