NCMS/News Channel 14 Forum on Health Care Reform Available to Members and Public

If you haven’t been able to view or take part in the “Health Care Reform and You” forum jointly produced by the NCMS and News Channel 14, you still have an opportunity to watch this important event. Taped before a live audience Wednesday night at Central Piedmont Community College in Charlotte, NCMS cosponsored the forum in order to educate the public about the new health system reform law.

The forum featured six prominent panelists:

          Michael Dulin, MD, Family Medicine, Charlotte

          Jeffrey P. Engel, MD, State Health Director

          Ophelia Garmon-Brown, MD, Family Medicine, Charlotte

Maureen O’Connor, Executive Vice President/Chief Strategy Officer, Blue Cross Blue Shield of North Carolina

Robert W. Seligson, Executive Vice President & CEO, North Carolina Medical Society

Michael C. Tarwater, CEO, Carolinas Healthcare

News Channel 14 broadcast the event Thursday night at 7:00pm and will re-broadcast it on Sunday, September 26, at 1:00pm. It can be viewed in communities served by Time Warner Cable, which also offers viewers a chance to see it via Carolina On Demand.

NCMS staff member Amy Whited provided coverage of the forum through the Doctor to Doctor blog, which can be viewed at .

If you do not have Time Warner Cable service, you can watch the program on the News Channel 14 Website at:–health-care-reform—you.

NCMS wishes to thank News Channel 14 for helping to make this program possible and looks forward to future collaborations in order to provide programs that can educate the public about important health care issues.


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  • Linda S. Winegardner, MD

    September 30th, 2010

    Subject: Insurance Company Policies and Healthcare Reform

    The physician owner of her private family practice and I went to a “Health Reform and You” forum sponsored by the North Carolina Medical Society and Channel 14 in Charlotte on September 16th, 2010. It was a fairly generic review by leaders of “Big Medicine” and state level leaders of how the Reform would affect patients and the medical industry. What stood out to me was the lack of representation and experience of the small independent medical practice. When asked by the moderator about the impact of Healthcare Reform on physician pay, one panelist said it would have no effect because she was salaried! Though she was making light of the matter, her answer was that of an administrative person who apparently no longer had patient care as her primary duty and did not fully appreciate the role of the independent medical practice. She and the panelists represented how healthcare has grown from a medical service between a patient and doctor to that of an industry that has a bloated bureaucracy that must be fed by the work of the medical provider. Having said that, there obviously is a place for big medicine and hospitals but I believe they have grown too big in their effort to dominate their particular market instead of providing an affordable health care system.

    Another panelist was asked about why the cost of health care was growing out of control. His response was technology/pharma, utilization, and our population’s behavior relating to the top three chronic diseases. I certainly respected his opinion and agreed to varying degrees on what he said but For-Profit insurance companies and “Big Medicine” should be added to the list of cost generators.

    For-profit insurance companies coordinate payment for almost 50% of health care in our country. They offer checks and balances to the medical business and consumer of health care services. But my experience is that the number one goal of the “for profit” insurance business is to show a profit and pay a dividend. I understand the profit motive but the impact is that we as a small medical practice and, probably as a health care “industry”, have not seen a real increase in our per patient revenue in many years. But still we hear of how the cost of health care is going up. I say it is the cost of health insurance that is going up – not the cost of health care! In the case of our small medical practice, it is a “give with one hand and take more with the other” type of relationship between us and the commercial insurance companies. Some may view that as cost containment but to small medical practices trying to provide responsible care, it is a death sentence. We contend that small independent medical practices are basically on death row awaiting the end!

    At the primary care level, we do what is needed to provide care and the diagnosis of a patient’s problem. As a small independent medical practice, we have no incentives to do unnecessary imaging or service. We also “got the message” about name brand drugs. We always start our patients on the generics and go to the name brands when the generics do not work. Big Pharma deserves profit to support their efforts and R&D but how many ED meds do we need!

    The answer to the escalating cost of health insurance is that America needs to initiate further health care reform by implementing a “Not-for-Profit” insurance program comparable to the Blue Cross Blue Shield model with oversight by government and the medical/scientific community.

    Big Medicine is another cost driver. At the primary care level, the costs are pretty simple: a provider, basic diagnostic services (labs and access to imaging), and basic administrative/medical support. The scale of these services depends on the setting (rural vs. urban) but they aren’t the things driving the cost of medicine up. What I see in the urban setting (Charlotte NC) is the competition between two large medical “factories” to dominate the market. In Charlotte’s case Novant and Carolina’s Healthcare have built some first class facilities and hired a lot of great providers. At some point these medical factories went too far and now must see A LOT of people or charge A LOT of money or both to cover the vast overhead of providing care. This increased demand on the “factory physician” to generate the income to pay for the overhead results in less time for the doctor-patient relationship. It also increases the chance for missing a serious health issue. But, never mind – it is the doctor’s malpractice insurance and credentials who suffer – not the medical factory. Maybe the income demand even creates pressure to over utilize the state of the art imaging and other technology? No wonder insurance requires pre-authorizations, tort reform is frozen, and doctors are “burning out”.

    A possible answer to the growth of Big Medicine is to reimburse a flat fee (like Medicare) regardless of who is providing the service. This flat rate puts everyone on a level playing field – same rate for small and big medicine. This approach would help reduce non-productive overhead while recognizing the value of procedures and more complex medical services.

    Finally, insurance companies now have a monopoly on payment for health care costs. As previously mentioned, the profit motives of these companies drive their policies and contracts. They have tried to drive costs down by restricting or discouraging utilization of non-generic drugs, diagnostic services, and medicines/vaccines. The suppliers of these services and medicines have positioned themselves to charge up to the limit of what the payers will pay. The result is zero margin or loss on the value added by the medical practice for these services and supplies. It was these margins that helped cover the cost of providing medical service. With these margins removed the consequence is reduced service to the patient and a threat to the viability of the medical practice.

    Insurance payers are going even further in their effort to control utilization. They have crossed the line and told medical practices and even hospitals which lab vendors they can use. United Healthcare tells us we cannot use our preferred lab. Aetna says we must use another lab. What happens when Cigna says that we must use yet another lab!

    It is our position that the insurance companies should stay out of the business of telling medical practices which vendors we can use. Due to our small size (70% of family practices are less than two doctors), we must negotiate our best rates with our vendors based on the volume of business we can give them and the service they can give us. We lose the ability to negotiate best pricing when we have to distribute our work over several vendors. This policy also increases our costs and the possibility for errors when we must manage multiple labs. These vendor policies directly impact patient care and the cost of providing that care without commensurate reimbursement.

    The bottom line is – payers need to establish fair reimbursement with the medical practice and let us manage our business and select our vendors. We currently break even at best with lab and medicine reimbursements. All of our expenses must be covered by the E&M reimbursement – very different than five years ago when labs and medicines helped pay the overhead.

    Small medical practices are barely surviving – many are going out of business. This may sound good to “Big Medicine” since the insurance companies will have no one else with which to negotiate. But it is not in the interest of the insurance industry and certainly not in the interest of the patient.

    The impact of “consumer driven healthcare” is doing what the insurance companies intended. Patients are using their benefits less and paying more out of their pockets. The medical practices are adapting as best we can to survive to the reduced revenue and increased administration costs. This “perfect storm” of the economy, reimbursement, and utilization policies are making it hard to keep the doors open. The bottom line is that we would like the insurance companies to stop implementing policies that continue to drive up our costs and stop implementing one sided contracts that produce a net reduction in reimbursement year after year.

    In summary, it is unlikely that a “single payer” option will be implemented any time soon due to the lack of political will and special interest push back. Therefore to restore a robust, affordable and responsive health care system, a “not-for-profit” insurance model needs to be promoted that reimburses fairly and respects the medical businesses’ right to manage its interests.

    Thank you for taking the time to read the thoughts of a small independent medical practice manager and doctor on this subject. We truly believe the small independent practice will soon be a thing of the past. Not because of its inability to provide quality, low cost care but because of insurance company policies that are forcing it out of business. We hope the leadership of our professional associations and others recognize how they can preserve this important part of the health care community by addressing these issues.


    Vince Winegardner
    Practice Administrator

    Linda Winegardner, MD/AAFP/AMA/NC Medical Society