With UnitedHealthcare being forced to outsource its database physician out-of-network payment rates, doctors may have a better chance at getting paid what they bill. This is certainly a good thing for the medical community, which had every reason to be distressed by the extremely low balled numbers.
Unfortunately, it doesn't look like the proposed solution is really a solution. The academic who will run the FAIR database--the new, nonprofit version of the Ingenix rate compilation--is already hedging on whether the new numbers will be higher than the old ones.
Please note that I'm not attempting to challenge Dr. Freund's honesty or ethics. In fact, her candor about the research is refreshing. You know an insurance company flack would refuse to answer the question directly.
That being said, it's very hard to avoid the influence of health plans, which have funded the database to the tune of almost $100 million. Maybe there's procedural safeguards in place to make sure health plans don't meddle, but if they exist I haven't seen any record of it. And anyone who's been exposed to the nonprofit world knows that while nonprofits are supposed to be independent, they're quite influenced by the people who write the checks.
What's more, I see no sign that any physicians not on the nonprofit's payroll will be directly involved in the process. Again, it might be that the FAIR organization has a strong physician advisory board in place, but I've seen no mention of such cooperation as of yet.
My feeling is that New York Attorney General Andrew Cuomo, clearly an aggressive, smart guy who's taking on big issues, actually missed a bet here. While his other health plan-related efforts--such as revising physician rating systems--specifically involved physicians in the process, he seems to have dodged the issue this time around.
Ultimately, the FAIR folks need to be independent of both health plans and doctors, of course. In theory, the numbers are what they are and it's really nobody's fault. In practice, though, it's no problem to make the numbers bend in whatever direction you'd like.
The bottom line is that if FAIR doesn't include a substantial pay hike, it's going to fail, as physician groups aren't going to take it lying down. Let's hope, for the medical profession's sake, that someone thinks to involve doctors in the development process. Otherwise, that $100 million may go to waste. - Anne