It’s not a bet­ter way to end prob­lem of bal­ance billing

Modern Healthcare - - COMMENT -

Re­gard­ing the Sept. 7 ed­i­to­rial “A bet­ter way to end bal­ance billing” (Mod­ern Healthcare, p. 24): It’s an out­ra­geous as­sump­tion that al­low­ing one “provider” to de­cide how the al­lo­ca­tion of re­im­burse­ment is to be dis­trib­uted is a rea­son­able so­lu­tion. There is no way this will ever be viewed as fair and rea­son­able by providers who are not in con­trol of that dis­tri­bu­tion. Crony­ism and in­ter­nal net­work con­nec­tions will cor­rupt it, I guar­an­tee it. The bet­ter choice is to force the hos­pi­tals to re­quire that their con­tracted physi­cians (emer­gency room doc­tors, ra­di­ol­o­gists, pathol­o­gists, anes­the­si­ol­o­gists, etc.) be on con­tracts that mir­ror theirs. They can force this is­sue, but they have not been dili­gent enough to do it. The way to get ev­ery­one in line is to not give the power of dis­tri­bu­tion to an in­di­vid­ual or sin­gle en­tity. You are ef­fec­tively cre­at­ing a “monar­chy” where the king or queen will de­cide how the money gets dis­trib­uted and hos­pi­tal net­work physi­cians will get pref­er­en­tial treat­ment to the ex­tent that it will be abu­sive. Take the cor­po­rate large prac­tice spe­cial­ties and make them be in-net­work as a re­quire­ment of their con­tract with the hos­pi­tal.

Dr. Michael Bryan

South­lake, Texas

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