Tuesday, August 20, 2013

Fwd: qotd: AHIP seeks reversal of "any willing provider" clauses

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-------- Original Message --------
Subject: qotd: AHIP seeks reversal of "any willing provider" clauses
Date: Tue, 20 Aug 2013 07:45:25 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

American Medical News
August 19, 2013
Insurers seek limited insurance exchange plan networks
By Jennifer Lubell

Health plans are focused on being ready "and doing what we need to do"
as states set up their respective marketplaces, said Karen Ignagni,
president and CEO of America's Health Insurance Plans.

But some policy concerns remain. Many states, for example, "still have
restrictions on our ability to actually provide high-performing networks
for individuals to be able to access high-performing doctors and
hospitals to make sure again we're stretching those dollars. That will
have to be looked at," she said.

Ignagni was referring to the "any willing provider" clause, a mandate in
some states that requires health plans to allow health care
professionals to participate in a health plan's network if the
professional agrees to a plan's contract terms, limits and conditions.

She also encouraged giving nurses a broader role, joining them with
other professionals as part of health care teams, "so that we can try to
customize health care and make it very patient-centered, and again
stretch those dollars."


Comment: Insurer opposition to "any willing provider" clauses is yet
one more example of why we should question leaving coverage decisions in
the hands of the private insurance industry.

Any willing provider clauses allow care provided by any qualified
physician to be covered even if that physician is not contracted by the
insurer but is still willing to accept payment based on contracted
rates. The advantage of such clauses is that patients may choose to
continue to see their own physician as long as the physician agrees to
the insurer's rates.

Why would insurers want to prohibit patients from having that right? It
has to do with their current strategy of switching to narrow network
plans - plans that have fewer choices of health care professionals. They
say that they can extract even greater discounts from physicians who
believe that they will have more patients referred to them by the
insurer. Although it is questionable as to just how much further the
insurers can ratchet down rates, these limited network plans have the
advantage for the insurer of further impairing accessibility, thereby
resulting in savings from forgone care, no matter how important that
care might be.

Besides reducing the number of physicians in their networks, they also
want to increase the number of nurse practitioners, presumably because
they can negotiate even lower rates with them than they can with primary
care physicians. That assumes that the current movement by nurse
practitioners to gain equal pay for equal work will fizzle when the
insurers offer the bait.

When they say this isn't about the money, but it's about quality… No,
wait, they do say that this is about "stretching those dollars." But how
should those dollars be stretched? Should we take away choices of
physicians and substitute nurses unwillingly, or should we consider
eliminating this egregiously wasteful industry with its unwelcome
intrusions? The latter would not only produce immensely more savings, it
would also be much more beneficial for patients.

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