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July 24, 2007
EXCLUSIVE AT POST SCRIPTS
Doctors Facing Bankruptsy
by Jack Lee
This is something so serious, it is literally threatening to force many doctors out of business in the very near future.
UnitedHealth Groups decided to use the ACN Group of California as it's provider network. In order to improve their bottom line ACN slashed the reimbursement rates so low that chiropractors will not even be able to cover their own costs of providing patient care.
According to one local doctor that break even point runs about $28 per patient. And that is all ACN is allowing for reimbursement! To make matters worse, UnitedHealth merged with PacificCare of California and the patients from the second largest ever merger in managed care all went to ACN. That one merger gave ACN an almost monopolistic leverage to alter the referral network and either force doctors to accept the ACN reimbursement rates or leave the network abruptly. If the doctors try to leave there goes the bulk of their patients and they have to begin anew building up their patient inventory.
To make matters worse ACN requires more paper work adding to the office overhead and the ACN does vigorous oversight to prevent doctors from too many extra costs, such as X-Ray's or orthodic appliances that could help the doctors bottom line. That part is good for ethics and these doctors support reasonable oversight, but sometimes computer generated red flags pop up when there is no problem. Many of the doctors are feeling almost intimidated by this sort of heavy handed oversight.
According to the California Chiropractic Association, "With a combined market share of 26 million members, health care providers are faced with the agonizing choice of dropping the network and immediately losing a large percentage of their patient base or remaining part of the network and losing money on each patient until they can slowly transition away from accepting UnitedHealth Group patients.
Over the last decade the cost of an office visit to a Doctor of Chiropractics has not even been allowed to keep pace with the rate of inflation. A typical office visit in 1995 was about $29, today it is around $35. With the ACN taking a larger bite of their scant profits, California Chiropractors are being forced out of business and ultimately this means fewer choices for the patient. I happen to be a believer in chiropractic care and it's saved me from expensive and risky surgery, no doubt many of our readers have had a similar experience. If one can avoid surgery it seems to me this would be a great cost saving benefit to insurance industry and they would be more supportive of this area of patient care, but in practice it's just the opposite.
“Unacceptable aggregations of market power by health plans should not be allowed to the detriment of consumers and health care professionals,” said Kassie Donoghue, CCA president.
Folks, our private healthcare system in California has hit some serious snags and not just for Chiropractors and their patients. Currently the average family of 4 pays about $1100 a month for health insurance which has been growing by leaps and bounds for decades. At the current rate of growth we could be looking at an average health insurance policy for that same family costing over $2100 a month in the next 5 years. If that happens we will see more families dropping their health insurance. The uninsured gap will grow significantly for those too poor to afford insurance and those making too much money to qualify for Medical. That new and unhappy voter group would only strengthen the base of support for those now demanding socialized medicine for California.
Is that what you really want, a government run healthcare system?
We have to make some tough health care choices in the very near future and I am not sure the mix in our current State Legislature is up to it. If they fail, then by default the socialized medicine lobby will win.
From the ACN website: "George DeVries began working with the Minnesota-based American Chiropractic Network (ACN), a provider of management services to independent chiropractic provider associations that wanted to expand into California. With $5,000 of his own money, DeVries established himself as the exclusive management and marketing company for ACN in California, encouraging managed health care plans in the state to offer self-referred chiropractic benefit plans through the company.
Under DeVries' leadership, ACN obtained California's first chiropractic HMO license and profoundly impacted how the California HMO industry offers chiropractic benefits."
Posted by Post Scripts at July 24, 2007 10:25 AM
Comments
wow. who would have known!!
Posted by: mvin belli at July 24, 2007 11:55 AM
Chiropractors? ! ?
'bout once a week I tune in to see if there's anything worth responding to ...
Nope. Not this week neither ....
Posted by: Libby at July 24, 2007 08:41 PM
"mvin belli"...that's quite funny...Jn edwrdz.
Posted by: Tina at July 24, 2007 09:43 PM
Jack I'm not sure I get the gist of this particular story but the bottom line for all of our healthcare woes is if we don't get the government out of the mix we are doomed...patient, doctor and insurance provider.
Posted by: Tina at July 24, 2007 10:02 PM
'bout once a week I tune in to see if there's anything worth responding to ...
Nope. Not this week neither ....
Pick your own topic...go ahead...I dare you!
Posted by: Tina at July 24, 2007 10:15 PM
Unfortunately the gist of this story is when mega-mergers happen there is the law of unforseen consequences. In this case nobody in gov. was looking too hard when they allowed this merger or they could have seen this problem coming.
A huge merger often mean fewer choices for the consumer and that can't be good for capitalism or patients.
This company called ACN is trying to turn a profit on the backs (no pun intended) of cash strapped chiropractors and they have capped what the docs can charge and how many visits they can get per patient.
ACN has a virtual patient referral monopoly (they take fat $$ cut for referrals). It makes transitioning away from ACN very difficult for the docs. With all those patients in the ACN referral system there's not much left outside the system to restablish a patient base for the docs. They are in trouble no matter which way they go.
Posted by: Jack at July 25, 2007 07:46 AM
Monopolies certainly don't work and as we have seen HMO's don't work well either. Neither represent the free market so what "tough health care choices" can the legislature make here? (or were you talking about the public?)
Once upon a time when the earth cooled (as Medved always says)...people purchased insurance to "insure" against catastrophic occurances and NOT so that others would pay for therapies, yearly doctor visits and sore throats. We pay for maintenance on our cars and homes and other things in our lives, why do we think our healthcare should be different?
If we continue on this insane course we will soon be asking "someone else" to pay for ALL personal expenses. When the whole ponsy scheme colapses and we find ourselves living in a third world socialist atmosphere that flat hand slap to the forhead might happen...but I doubt ti.
What we need is a major program that forces people to grow up!
Posted by: Tina at July 25, 2007 09:56 AM
Oh, you guys are just terribly inexperienced. Kaiser works, more or less, beautifully. And it is bald-assed socialism. Everybody pays into the pot ... the sick people take what they need out of the pot ... and Kaiser's administration does its damnedest to see that the ratio of sick people to well people doesn't put them out of business ... as in: "Eat your greens and exercise, for freakin' pity's sake! We don't want to see you in here!" It is absolutely, entirely, the best thing.
Posted by: Libby at July 25, 2007 10:04 PM
Libby I can always count on you to initiate some research...stay tuned on the Kaiser claims. Right now I need some zzzzzzzzz's.
Posted by: Tina at July 25, 2007 11:15 PM