Who do doctors work for?

Hmmm, who does the doctor work for? Think again. They may not have much of a choice.

When patients are suffering from life-threatening illnesses or debilitating health conditions, the only thing that should matter is delivering appropriate evidence-based treatments in a timely manner. For that, patients rightly turn to us — their trusted physicians — for expert guidance on the best course of action. Yet, all too often, insurers insert themselves into the equation. As a result, restrictive policies like prior authorization can interfere with patient care — and lead to dangerous and painful outcomes.

Barbara Jung, MD, and Deborah Dyett Desir, MD

Read the entire article here

What are the stipulations for physicians? Let’s look at the Pros and Cons. Ah, so much to ponder.

In Network Practice

Pros

• Access to a Larger Client Pool
  • Being in-network with can make a doctor’s services more accessible to potential clients who prefer or require insurance coverage for health services.
• Increased Client Retention
  • Many patients prefer the convenience/affordability of using their insurance benefits.
• Predictable Income
  • In-network providers typically have more predictable and consistent income because medical insurance companies reimburse for services based on predetermined rates.

Cons

• Lower Reimbursement Rates
  • In-network providers often face lower reimbursement rates compared to out-of-network or cash-based practitioners. These rates may not fully reflect their knowledge and expertise.
• Administrative Burden
  • Dealing with insurance companies can be administratively demanding, involving billing, claim submission, benefits verifications, authorization requests, etc.
• Limited Control Over Client Care
  • Some insurance companies may dictate the type and duration of treatment, potentially limiting the doctor’s autonomy.

Out-of-Network or Cash-Based Practice

Pros

• Higher Earning Potential
  • Out-of-network or cash-based practices allow physicians to set their fees and potentially earn more for their services.
• Greater Clinical Autonomy
  • They have more control over the treatment methods, frequency, and duration of sessions, ensuring that patients get the best care possible.
• Reduced Administrative Burden
  • Without insurance billing, they have more time to dedicate to their practice.

Cons

• Narrower Client Base
  • Some clients may be unable or unwilling to pay out-of-pocket for health services.
• Financial Insecurity
  • Depending solely on self-paying clients can lead to more peaks and lulls in their practice.
• Marketing and Networking Challenges
  • Physicians need to invest more time and money marketing and networking to build and sustain their practice.

Anyone have a headache yet?