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Doctors, Insurers at Odds Over Proposed Law

Posted on: Monday, 11 July 2005, 03:00 CDT

A proposal to allow doctors collective bargaining rights against insurance companies has doctors and insurance groups at odds as to whether it would cost or save patients money.

Doctors contend current laws leave them unable to negotiate their way out of contracts that create excessive overhead costs. "It's not an economic system," said Stuart Hayman, executive director of the Westchester County Medical Society.

Insurers shoot back that the measure would open the door for unionized doctors, driving up compensation rates and with them health-care premiums. "It's ultimately about money," said Leslie Moran, senior vice president for the New York Health Plans Association.

The bill, one of a succession proposed by the New York State Medical Society over the last decade, would allow doctors to form or join associations to negotiate non-rate-related issues in their contracts with health insurers.

LIMITED BARGAINING POWER

The organizations, which would be monitored by the state, would not be authorized to call strikes or boycotts.

Negotiations over reimbursement rates would be allowed only when a single insurer controls a "substantial share" of a given market.

That would apply mostly in rural counties, said Assemblyman Ron Canestrari, an Albany-area Democrat and the sponsor of the bill. "In some areas, there's only one game in town," he said.

These kinds of situations prompted the call for this legislation, said Dr. Martin Fox of Scarsdale, who is the head of the New York State Medical Society's legislative body.

Currently, only large medical groups, such as the Mount Kisco Medical Group's 100-plus doctors, can effectively negotiate with insurers, Hayman said.

For most doctors, joining or forming such a large group isn't feasible, he said. To work well in a group, doctors need compatible ideas on medical and business practices, and compatible partners can be hard to find. "Just getting one plus one is tough," he said. "Getting 1,000 together under the same roof? I just don't see that as an option."

Without that kind of negotiating power, doctors end up accepting reimbursement rates and contract clauses that they would not otherwise accept, said Dr. Andrew Kleinman, past president of the medical society and a New Rochelle plastic surgeon. "It would make it much more it level playing field," he said.

The conditions, which range from such things as limits and conditions on types of treatments to mandating mediation in billing disputes with the insurer, interfere with patient care and cause doctors to spend increasing amounts of time and money dealing with HMO paperwork, he said.

DOCTORS SHUN INSURERS

Kleinman said he himself no longer takes insurance to avoid problems like this, and that many doctors have followed or are following suit, either for a particular insurer or for all insurance.

However, many doctors can't afford the business loss such a move would entail, Fox said. "It's not an option," he said.

Moran, for her part, said the measure would eventually lead to what would effectively be doctor's unions, forcing insurers to pay higher compensation rates and driving up insurance premiums.

Doctors are already respected and well-compensated, she said. "We. don't think they need collective bargaining rights," she said.

PROPOSAL TO SAVE MONEY

However, Hayman argued that the proposal would ultimately save both sides money. Giving doctors the ability to negotiate away some of the more burdensome contract conditions would save both doctors and insurers from the paperwork costs associated with enforcing them, he said.

While the measure contains no provisions to force insurance companies to the table if they don't want to negotiate, Fox said it still provides a better method of resolving disputes than going to the legislature, such as when doctors lobbied for and got a law against insurance company rules that limited how long they would pay for a new mother's hospital stay.

While Moran said her organization was taking the stand that the proposal would violate federal antitrust laws, Canestrari said the bill has gone through several changes to meet those objections.

Still, he admitted that the argument that doctors have enough respect and money without collective bargaining has hurt prospects for the proposal. "I can't say I'm seeing a lot of support for it," he said.

Over the last decade, similar proposals have passed the Assembly before, but never the state Senate. With the bill still in the Assembly Ways and Means Committee and the legislative session ending in a few weeks, it's unlikely to pass this year. "But we'll keep fighting for it," he said.

Copyright Westfair Communications Jun 13, 2005

Source: Westchester County Business Journal

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