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Doctors Going Broke–You Can’t Even Give a Practice Away–Only Folks Buying Them Are Hospitals and Insurance Com

Posted Jan 06 2012 3:27am

That’s the word from MDs in southern California anyway from several of the ones I know and according to this CNN article it extends way beyond this geographical area.  I’m talking about cardiologists, internists and oncologists that I know so this reached beyond the family practice doctor.  Divorces when they occur get even more interesting with many that rely on their spouse to work in the office so when that happens they lose basically “free” labor too. image

What I found interesting with this article is the quote from an executive with a cancer center in Newport Beach, a pretty affluent area in the OC so give that some thought as if the doctors in Newport Beach are having issues, what does that say for the rest of the country.  This has been developing over time as when I was still developing software and spending time with MDs back 6 years ago things were tough then.  Part of some of the first work I did consulting was to create some custom data base programs and spreadsheets so doctors could reconcile their capitation payments as we always had “floating patients” and shortages were there from the HMOs years back before Health IT had evolved so been there, seen that and done that to help them get proper reimbursements. 

In California doctors are not allowed by law to work directly for a hospital so they all belong to physician’s groups.  The new graduates from medical school are looking for the salaried jobs.  The big court battle in 2010 with the City of Hope hospital and the physician's group pretty much set the stage in California for doctors having even less of a voice in healthcare.  That was a pretty ugly battle as the doctors has to disband their group and join one created by the hospital in essence. 

As a matter of fact, United Healthcare bought the big HMO group, Monarch healthcare in the OC not too long ago and see the havoc it’s already creating over “contracts”. 

Here’s another article I wrote a few months back too as insurers reinvent themselves at IT companies with a ton of mergers and acquisitions below, one division cuts reimbursement contracts and then another subsidiary runs in to sell them additional software and analytics capabilities so they can keep what is left, so talk about control on reimbursements. 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

It’s all the math and business intelligence done for profit and doctors have been an easy target as they are doctors first and then business people and the second is not even taught in medical school for the most part.  I don’t want my doctor for that matter to be a business person either. 

Welcome to the world of discrimination by the algorithm….

One thing for sure consistent care with providers is definitely becoming one big disrupt for all, and it comes down to the buck and this is what digital illiterate Congressmen and Key Executives allow to happen, they are out of touch with the real world.

I guess again due to how I fell into Health IT and what I created for relief in reconciling EOBs years ago, that is why I pretty passionate here as you can’t help but be that way once you have seen it enough.  Once again we come back to the math and as I wrote yesterday, I sure hope our new Consumer financial watchdog knows math or we are up a creek and doctors are right in there with us. 

We have Andrew Cuomo to thank for the 15 years of short payments from insurers to doctors as well who caught the folks at Ingenix low balling the numbers.  United created it and the rest licensed it so all the big insurers paid doctors at a lesser rate for 15 years and the case was just settled by the AMA last year.  Again, this is why I look at the math and the numbers as writing code has taught me not to believe what I hear in promises but rather I look at the bottom lines, queries and so forth for my opinions and answers. 

I know of another specialist having rounds with Aetna with “one” patient that threw off his average and now he/she is no longer a “good” doctor that does costs because the patient had to be referred to the specialist’s specialist and no carrier cover those folks but they did approve it and then later come back and denied the approval.  Most insurers do that when a patient needs the technical specialist that can save a life beyond what is normally practiced.  They want the doctor to absorb and eat all the bills for the hospital and the specialist now and will probably cancel the contract as again, it took “one sick patient” who’s life by the way was saved but it has kicked this MD out of favor with Aetna as it blew the average algorithmic scores and the risk analysis predictions on this doctor out of realm. 

Doctors too are under the attack of the killer algorithms.

Attack of the Killer Algorithms-Occupy Wall Street Part 4 Health Insurance Style - One More App For Folks Who Are Tired of Flawed Algorithms That Require A Ton of Work and Research Time To Create “Perfect” Data Files for Insurers And Others Analytics Processes

Big corporate USA and the banks are turning doctors and consumers into data chasers to clear up all the flawed data out there and we will all go broke chasing their data for analytics they use that seem to have a very low level of forgiveness when it comes to humans ethics.  You can find all the of “Killer Algorithms” posts here if you want to read more.  Peer groups don’t even understand the contract either at the hospitals, good example at the link below as the doctor tells the story.

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

Here’s another example from 2010 of a practice running out of money.  You can hear him say he wants to take care of patients and unfortunately this is happening in other parts of the country as well.  Insurers keep making record profits and consumers lose houses and doctors go out of business.  BD 

NEW YORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes.


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