Will Anyone Pay For Your Care?

Last week, a drug company bought lunch for me and a group of physicians. There was no sales pitch nor a discussion of any drug. The drug company representative sat and listened as physicians discussed their increasing difficulties practicing medicine.

One of the doctors told his consultant that he was going to stop sending him patients because consultations were being scheduled two to three months after the patient called. The consultant, in turn, complained that he was experiencing a practice-crippling "no show" rate of fifteen percent, notwithstanding confirming calls the day before appointments. He and other physicians described increasing difficulty in collecting accounts receivable in a timely manner from payers. They complained that their staffs' energy, and their own practice time, was being wasted by insurers who refused or delayed authorizing medicines for individuals with serious medical problems. They observed that loss of employment means that one day a person has health insurance and the next day she doesn't, and won't show up for a needed medical appointment.

I asked whether any of these physicians had ever asked to see the financial statements of the HMOs, PPOs and indemnity insurers with which they do business and have burgeoning accounts receivable? Had they ever considered that they were at risk of non-payment because the companies might be under financial pressure, like other financial institutionsin our depressed economy? Had they thought about the possibility that payers were not approving medications because they were having cash flow problems?

Not one physician had considered doing what small businesses know: beware of financial weakness in businesses that owe you money. Although one physician group in the area in which these physicians practice had declared bankruptcy several years ago, leaving some of these doctors with substantial losses on accounts receivable, not one physician had factored the concept of business risk into his or her financial plan or willingness to contract with, or render services to, patients of HMOs, PPOs and indemnity insurers. Many of these physicians were driving down their own income by doing business with companies which paid substantially less than the rate paid by their average payers which in some cases, was less than the physician's cost of providing services (allowing these companies to grow by undercutting the rates charged to employers by better paying payers).

Under these circumstances, would anyone actually expect physicians to oppose a single payer system? Not likely!