The dilemma of managed care

In early January, a newspaper article in the Florida Times-Union in Jacksonville told readers that 65,000 Blue Cross Blue Shield (BCBS) members were faced with a dilemma:

Because BCBS had failed to come to a contract agreement with a large medical group, insured members would either have to find other doctors or pay higher out-of-network fees.

I suspect by the time you read this, BCBS and the doctors' group will have come to terms. However, whenever employers change insurance companies, their employees are often faced with the same dilemma: Find a new doctor in the approved insurance network or pay higher out-of-pocket fees.

Many people opt to find a new doctor.

I don't have to tell you about the problems related to managed-care organizations. You know how they demand detailed paperwork, deny claims (often, it seems, without reason), and cut reimbursements.

Despite these hassles, however, joining managed-care networks — as many as you can get into — has a definite advantage: They offer you access to patients you might not otherwise have, because patients tend to go to doctors who are in their insurance network — a fact that Dr. Joseph V. Haezebrouck, whom we feature in this issue's Success Profile, emphasizes.

If you work with networks, consider educating your patients about the difference between healthcare and wellness care. The article on page 57, "Change your patients' perceptions," will guide you in this.

An alternative to dealing with managed-care networks is to convert to a cash-only practice. Last fall, when we surveyed you about fees and reimbursements, we found that 21.1 percent of respondents claimed they operated cash-only practices. That was up from 11.7 percent the year before.

Surveys are not infallible; perhaps the increase in cash practices was an anomaly. We again ask that question in our 10th Annual Salary & Expense Survey, which is open throughout February. We will report the results in Issue 8, which will be published in early May.

We hope you enjoy this issue, which provides some excellent food for thought on managing managed care, as well as other practice-building advice.

Until next time,

Linda Segall, Editor-in-Chief