I read with interest the “Practice Page” comments that rheumatologists are in position to demand more in contracts [February 2013, p. 21].
Interesting, but seemingly not true. The situation is actually more draconian! This is exemplified by BlueCross BlueShield of Kansas City. They were ready to accept me into their plans, but would not accept my signature.
My signature states “Bruce Rothschild, assuming due diligence, ethical behavior, noncompromise of patient care and in accordance with routine billing practices.”
They refused to accept this signature, claiming that it “would CHANGE THEIR CONTRACT.” They refused to be held to the standards of due diligence, ethical behavior, noncompromise of patient care, and adherence to routine billing practices.
While it is my impression, at least in the state of Kansas, that insurance companies are essentially unregulated, routinely violating those standards, BlueCross of Kansas City, which writes many of the insurance policies in Kansas, is flagrant.
I look forward to learning of your perspectives.
Bruce Rothschild, MD
Professor of Medicine,
Northeast Ohio Medical University
Research Associate, Biodiversity
Institute, University of Kansas
Dr. Baraf Weighs In
I am grateful to The Rheumatologist for reporting on my talk, “Deal Breakers in Managed Care Contracting,” at the annual meeting of the ACR last November. I wish to add some important points that were in my discussion but not reported fully in the article. Although the title indicated a “take no prisoners” approach, the thrust of my discussion was to look for areas of commonality between provider and payer and emphasized relationship building.
Successful negotiations are the byproduct of two parties seeing their needs met by reaching an agreement. Higher reimbursements to the rheumatologist may enable a plan to maintain network capacity and access to care for patients and may provide savings to the health plan by moving services from more expensive settings to the rheumatologist’s office. Illustrating areas of savings to the insurer and the import importance of access to rheumatologists for patients in their network may motivate a payer to increase reimbursements. So, too, may the threat of the loss of this access and disruption of service to scores of patients incentivize payers to meet the rheumatologist’s demands. Of course, larger groups are better able to conduct negotiations and get a payer to listen and respond to “asks” than smaller groups or solo practitioners.
Perhaps the most important element in a negotiation is for each party to recognize the integrity and operational requirements of the other. Such factors that led to Dr. Rothschild’s suggestion should be dealt with during the negotiations. I cannot overemphasize the need for fostering collegial relationships with the insurer’s negotiator, as that person rarely has the last word and must bring your requests to higher-level administrators within their organization. This person, in essence, negotiates for you.
