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Insider Vision
Wants versus Needs
by Barry Scheur, President
We are at a crossroads for healthcare - failures not just of containing costs, but of trust and belief. Physicians don't trust health plans to pay them appropriately, to not interfere with the medical advice that they believe is in the patient's best interest, or even to be willing to discuss, as opposed to dictate, contracts and policies. For the most part, health plans are the sworn enemies, and if not that, the feared antagonists.
So what is the real truth when it comes to what physicians want? Are they rational in their trying to strike down all managed care? Are they acting like little children because their autonomy, not to mention their payment levels, have been undermined? Or are they willing to listen to and participate in framing rational alternatives? The questions are: Who's talking? and Who's listening? and Who's guilty?
When you strip away all the rhetoric, unfulfilled promises, and antagonism, here's the simple truth.
(1) Physicians want honesty about who's calling the shots and how they are getting paid. Define the plan's medical policy, referral and authorization procedures, appeals procedures, and then stick to them. Be honest when it comes to payment terms and risks. Don't promise return of withholds if there aren't going to be any. Tell the truth about fee schedules, and about old unresolved claims.
(2) Physicians have a right to participate in shaping policy decisions about medical practice standards, so long as they are willing to stand by their decisions and support them with others. We, as the business side of the equation, need to listen more, talk less, and reach consensus together.
(3) Physicians want to believe in something that is constant and doesn't reinforce their constant cynicism -- policies that don't change month to month based on costs rationalized as being medically necessary protocols. In other words, we have to create trust before we can ask for participation in change.
(4) Physicians should be provided the resources to meet their needs in communicating with our customers. Is technology the answer?
We believe that interactive discussions in health plans through the use of consumer boards and/or physicians advisory boards, or via technological advances, in non-aggressive, cooperative and collaborative sessions are the way to improve dialogue and services. Making our needs known in a non-threatening, productive manner enhances each group's chances of getting their needs met. |
