“Hey David put that stone down. Don’t risk enraging the giant.”
So it is in Louisville, where a small band of academic doctors have dared to challenge the multi-billion dollar local beast, Humana.
The story, as reported on the front page of the Courier-Journel, describes how a small group of doctors are testing the waters of real economics, and that patients–otherwise known as consumers–are tasting the appetizer in what is sure to be a many course meal.
The story goes like this. The University of Louisville doctors’ group, an academic practice including many specialists, sub-specialists and super-sub-specialists, believe they deserve more reimbursement for their services. They asked Humana, a major third party payer in this market, for a 10% increase in reimbursement. Humana said, Ha, not only do we think you are not worthy of an increase, in fact, we are cutting you 10%.
Thus, there is no agreement.
The dispute means costlier care for people like Mark Endicott, a physics teacher at Kentucky Country Day school whose 10-year-old son, Jonathan, has diabetes. Jonathan sees Dr. Michael Foster, a pediatric endocrinologist, at least every three months for checkups and blood work.
“We really don’t want to switch from Dr. Foster,” Endicott said. “We have been with him six years, and he really knows us.”
Endicott said he has found only one other doctor in town who is in the same field and that the family likely will stick with Foster and pay the higher costs, as they did during the last UofL-Humana dispute.
As it stands presently, over 700,000 patients with Humana policies will have to pay higher out-of-pocket costs to see physicians who believe they are better. That is, better enough than their peers to garner higher compensation. In this case, the doctors are University doctors, some of whom can even command robots. But they might have been ‘arrhythmia institute’ doctors, or ‘spine institute,’ doctors, or maybe they might just be the local magazine’s “Top Docs.” Or for that matter, any so motivated doctor who believes he/she is deserving of more than the “all doctors are the same” basal rate of compensation.
Humana doesn’t think this band of “providers” (as we are called by many third party payers) are any better. Moreover, they surely cannot have doctors believing there are differences in worthiness, or at least enough to warrant higher compensation. How dare doctors even consider behaving as if health-care could be market driven.
Patients who wish to keep their University doctor will have to decide whether to pay more of their own money. Is it worth it, they will ask themselves. This tug-of-war, I believe, is a glimpse into the future.
Surely healthcare cannot be more available, higher quality and less expensive. So, free health-care will be, wellâ€¦free. But to get more, more quality, more specialization, or perhaps in some cases, more hype, patients will have to adjudicate for themselves. Like they do at the dentist: are my kids teeth that crooked, or does my tooth hurt that much?
Expect many more switch backs on this very long ascent.