The burden was on the AAFP to present the findings here but the article states that United was surprised that they were paying less than Medicare.  I guess they don’t compare here and there?  United said they were going to do something about it but what remains a mystery as of yet.  When will the move from fee for service take place?  I think all insurers would like to move to that one but in the complex world today, it’s the IT infrastructure that has to be built to carry it before any changes are made.  The article continues on with suggestions on for doctors on how to negotiate better contracts.  If you read the comments, the doctors writing in on comments say it’s a waste of time as they don’t get that opportunity.

One doctor commented and stated that in south Florida they are paying 75% of what Medicare pays using a 2001 Medicare fee schedule.  Right now we have the annual issue with the SGR Medicare cuts on the table for doctors and just a couple weeks ago United posted this on where they look for saving…if those folks in Florida are only getting 75% of Medicare and have more cuts to look forward to?  They hired from HHS, Steve Larsen who was primarily responsible for writing the healthcare law, so now he sits as a VP at United. 

UnitedHealthCare Looks at Doctor’s Pay for Savings, Nothing New There Been Doing It for Years But Keep In Mind We Have the Annual Medicare Cut Fix on the Floor Again with Congress–Timing?

You tell me where the trust is after the 15 years of short paying doctors and hospitals was settled by the AMA, a real use of technology used against those who did not have it at the time.  Sounds like these folks are just like Jamie Dimon and Jon Corzine…”I don’t know” when you ask about money and business models. 

AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/Ingenix Class Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19

With all the analytics they sell and develop I would imagine their “quant” payroll has to be good sized when you bring in all their subsidiaries and their “quants” too as more money is coming from that end of the business than selling policies last I read.  Perhaps this reimbursement issue was one of those non linear calculations to match where there are relatively no matches or relationships in data?  By the way if you would like to see the credentials that your doctor has to meet with united to gain premium recognition or if you are a doctor and have not seen this, here’s the link to their pdf.  BD

A little more than a year ago, AAFP leaders and staff members met with representatives of UnitedHealthcare at our headquarters in Leawood, Kan. During that meeting, the Academy spelled out for the large private payer that its policy of paying fee-for-service rates that are below Medicare rates creates distressed practice environments and jeopardizes patients' access to care. 

At the time, United's leaders expressed surprise that the insurer was paying less -- in some cases far less -- than Medicare in some markets.

So where does that leave America's family physicians? Those of us who contract with UnitedHealthcare should be aware that when our contracts are up for renewal, there is an opportunity for re-negotiation, especially for those who practice in areas where the company has been paying less than Medicare rates.

United has said that it ultimately intends to move away from a strict fee-for-service system to a "value-based contracting model" that will offer physicians rewards based on quality of care. The health plan hopes to have up to 70 percent of the patients it covers affected by this approach within the next three years.


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