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Concerns About Doctors, Hospitals Treating Patients for Less

Sep 25, 2014

Tamaan Osbourne-Roberts is President of the Colorado Medical Society.
Credit Colorado Medical Society

Health insurance in the Roaring Fork Valley will be cheaper next year for some residents. The average premium will cost about seven percent less. For someone paying three hundred dollars a month, that’s about twenty dollars less for each payment. One reason for that is some doctors and hospitals are treating patients for less. And the state’s top association for physicians is worried that may have unintended consequences.

The Colorado Medical Society issued a statement to Aspen Public Radio on Wednesday, September 24, 2014, saying leadership there appreciates the effort to make health insurance more affordable. But President Tamaan Osbourne-Roberts went on to say it’s possible that downward pressure could mean poor health care. He’s concerned doctors could take on more patients to pay the bills, leading to longer lines, less access to care, and more people ending up at expensive Emergency Rooms. Read the entire CMS statement by clicking here or scroll down to the bottom of this article.

Representatives of Valley View Hospital in Glenwood Springs and Aspen Valley Hospital say neither institution has accepted lower payments from insurance carriers.

Ed Sealover is watching all of this closely. He’s a reporter with the Denver Business Journal, and says doctors have been charging more over the last number of years for a variety of reasons. That's not necessarily to make a profit.

Reporter Ed Sealover with the Denver Business Journal.
Credit Denver Business Journal

“The cost of drugs has gone up for providers to use. As there’s been increasing regulations, increasing testing required on those drugs, just to hit the market. The cost of medical equipment, is the same, much for the same reasons.”

And medical malpractice insurance keeps going up, also prompting doctors and hospitals to charge more. Sealover says health insurance carriers leaning on doctors to tackle those costs has been a surprising twist.

“One of the ways that they’ve started to look at bringing down rates is simply limiting some of the benefits without limiting the benefits. And I know you’re going to say wait, how is that possible. But what they’re doing essentially, and this is especially true in plans within the state’s health exchange, they are narrowing the network of who patients can see. By saying there’s only a certain number of doctors, certain number of specialists, certain number of hospitals you can go to. What this does is it allows the insurer to go to those health care providers and say ok, our networks are getting smaller. Do you want to be a part of this network and have access to all of our customers? If so, we’d like you to limit the amount of cost increases you’re asking of us, or in some cases, even accept lower reimbursements. And that’s really starting to come forward in the prices we’re seeing in 2015.”

Reporter: “Do you get the sense that any of this is strong arming, that physicians are being threatened with less access through insurance companies, and so they’re being coerced?”

Ed Sealover: “You know it depends—the use of the terms strong arming and coercion are probably all dependent on which side of this you’re talking to. Certainly there have been some murmurs national among physician groups, among hospitals, saying I’m sorry, I actually have to actually make money.I can’t take some of the rates these insurers are demanding.”

Sealover continued: “And there have also been concerns expressed by health advocate groups, saying, ok as you’re narrowing these networks, how much are you cutting down access. Are you making people who may not live in the metropolitan area drive farther now, to see a physician that would be in that network?  Are you overcrowding the physicians in that network and possibly making it harder for patients to get into see them? So in terms of the idea of is this not a good thing, in terms of strong arming, etcetera, there are those voices out there.”

In a statement to Aspen Public Radio, the Colorado Medical Society says its keeping an eye on the trend towards that shrinking of the number of doctors a patient can see through their insurance plan. Specifically the group is pushing for health insurance companies to have to make more information publicly available, to make sure patients still get good care. (See the full statement below.) State insurance officials say they’re running a study tracking this issue through 2015.

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Full text of statement issued by Colorado Medical Society on Wednesday, September 24th, 2014.

Statement of Tamaan Osbourne-Roberts, MD, President, Colorado Medical Society

Commissioner Salazar’s news that insurance premium increases will rise at a slower rate in the coming year is certainly welcome; it is also good news (inferred from decreased premiums) that more of Colorado's health care system has become better integrated and coordinated. The more physicians, hospitals, and other caregivers are coordinating with each other, the more costs will fall due to less redundant, higher quality care.

However, we know from long experience that simply cutting reimbursements without regard to value has the potential to cause havoc in the delivery system. Inevitably, the volume of services increases to offset such losses; additionally, good care is priced out of the marketplace, leaving behind large gaps in services, longer wait times, increased overuse of the emergency room as a high-cost primary care alternative, and care delays that convert simple problems to acute emergencies. In addition, physicians and medical students, rationally, begin to avoid service lines that are not economically sustainable, exacerbating physician shortages.

When health insurers began asking physicians to participate in products sold on the new health insurance exchange, CMS did hear that some of the companies would offer rates that were lower than other, existing commercial products. More than a few CMS members raised concerns specific to the narrowing of the networks for these products. It is our understanding that at least two of the companies who implemented these products have indicated that the narrow network products will not just be offered to consumers on the exchange but also will be part of their larger marketing strategy going forward. While we believe that these reports should be confirmed through interviews with the health insurance companies, the CMS House of Delegates, just last Saturday, passed policy affirming that as networks are narrowed, stronger transparency requirements are necessary to ensure that such networks are built on criteria that account for cost and quality.

CMS strongly supports additional collaboration between health plans and providers, and looks forward to our continued work bringing high-quality, low cost health care to all Coloradans.