The Challenge for Independent Health Care Practices
The biggest issue facing healthcare systems today, in my opinion, is the lack of control over their destiny. In a sense, perhaps, they never had any freedom, and mastery over their future was merely an illusion. However, after nearly 34 years in health care, it has become painfully clear to me that this is the biggest challenge facing independent groups and independent physician associations today. Payments, if they are part of managed care or accountable care, are often subject to the whims and fancies of the HMO or CMS. Rules can be changed arbitrarily, or retroactively, and data can be changed or hidden, or conflicted as needed. Payments arrive months later, sometimes 18-24 months late. Smaller practices do not have the means to challenge these numbers, nor the ability to review them on their own. Thus, they are dependent on health plans and CMS, being true providers of service and true producers of data, which are consumed by payers or regulatory authorities. PBM is a complete jok...