I find it interesting how financial pressures can negatively affect the workforce and access to care. Particulary, small and solo group physicians have a difficult time sustaining a private practice as they're usually at a disadvantage when it comes to contracting with third-party payors. Antitrust laws prevent small and solos from grouping together for contract negotiation, meaning many of them are effectively on their own when it comes to resources and leverage. Further, many of the physicians and their office staff have to expend considerable time and money (e.g., outside legal counsel) to examine the contractual amendments that are periodically implemented in their existing contracts. And once a fee schedule and contract is finalized, physicians face being denied payment for a number of reasons, leading them to expend administration costs in appealing. For private practice physicians who have an established client base, I can understand why some of them are looking to other solutions that don't involve third-party payor contracting.
I would add, however, that California does have the timely access regulations that were implemented in 2010 or 2011 - which require health plans to provide enrollees with appointments with physicians within a given time frame. So, there is a check-and-balance for in-network patients to receive care within an alloted time frame. Perhaps this policy could be applied on a federal level...
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I find it interesting how financial pressures can negatively affect the workforce and access to care. Particulary, small and solo group physicians have a difficult time sustaining a private practice as they're usually at a disadvantage when it comes to contracting with third-party payors. Antitrust laws prevent small and solos from grouping together for contract negotiation, meaning many of them are effectively on their own when it comes to resources and leverage. Further, many of the physicians and their office staff have to expend considerable time and money (e.g., outside legal counsel) to examine the contractual amendments that are periodically implemented in their existing contracts. And once a fee schedule and contract is finalized, physicians face being denied payment for a number of reasons, leading them to expend administration costs in appealing. For private practice physicians who have an established client base, I can understand why some of them are looking to other solutions that don't involve third-party payor contracting.
I would add, however, that California does have the timely access regulations that were implemented in 2010 or 2011 - which require health plans to provide enrollees with appointments with physicians within a given time frame. So, there is a check-and-balance for in-network patients to receive care within an alloted time frame. Perhaps this policy could be applied on a federal level...
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