Cover: Insurance company mergers must be rejected by regulators

Tuesday, March 01, 2016 12:00 PM

Proposals will jeopardize office-based physician practices

by Benjamin Kupersmit, president, Kupersmit Research

Eight years of survey research have pointed to intense concern among CMS members about the practices of commercial payers, from contracting to service authorization to claim reimbursement.

Physicians also increasingly shoulder the costs of helping patients understand and navigate their health insurance, including both the financial costs of wasted staff or physician time, as well as the immeasurable costs of degraded patient-physician relationships in exam rooms across our state.

It comes as no surprise that physicians – especially those who continue to survive in small, office-based practices – view the potential consolidation of Aetna-Humana and Anthem-Cigna with tremendous skepticism and concern.

Our recent survey concerning these mergers shows the following:

CMS members resoundingly reject mergers

• By a 68%-5% margin, CMS members oppose allowing the mergers to proceed (including 48% who “strongly” oppose), with 28% saying “neither” or “not sure.”
  • Among physicians in active practice, 73% are opposed (54% “strongly”).
  • Among decision-makers (physicians who participate directly in contract negotiations with commercial insurers), opposition stands at 79% (63% “strongly”).
• Nearly all decision-makers (who make up one-third of CMS members, and are largely concentrated among office-based, smaller specialty care practices) believe contract negotiations will be less favorable to physicians if the mergers are approved, with 85% saying as much.

Physicians expect higher premiums, less patient access if mergers are approved

• Specific impacts that CMS physicians expect to “definitely” or “probably” happen if the mergers are approved include higher premiums for subscribers (75%), reduced patient access to needed care (72%), lower reimbursements for providers (72%), more physicians pushed to an employee role (67%), reduced collaboration in patient care from payers (66%), more small practices out of business (66%), physicians forced to spend less time with patients (62%) and reduced investments in practice infrastructure (58%).
• If the mergers proceed, and they do not have a contract with the new merged entity, 44% of decision-makers say they will be forced to reduce staff or staff salaries, 35% say they will be forced to cut investments to practice infrastructure, 32% say they will need to reduce the time they spend with patients, 24% say they will need to close their practice and become an employee of a large group or hospital, 15% report they will move to another locale with competitive reimbursement and 13% say they will retire from active practice.

Insurers currently exert significant market power over physicians

• A majority (59%) of CMS members, and 80% of decision-makers, say they must contract with Anthem “to have a financially viable practice,” with majorities saying the same regarding the other commercial insurers we listed.
• Just 5% agree they can “turn away from an insurer and compensate for that lost revenue by treating more Medicare/Medicaid patients,” with 79% disagreeing (63% “strongly”).
  • Among decision-makers, 93% disagree (75% “strongly”).
• Nearly one-half of decision-makers (47%) have seen “take it or leave it” offers from insurers, and a similar percentage (44%) say they have seen “all products clauses” in contracts.

It is worth recalling data from our recent network adequacy survey, conducted in September 2015:

• One-half of CMS members (47%) have encountered payers who reject claims “without clear explanation,” 40% have seen unnecessary delays of “time sensitive referrals,” and 36% have experienced “phone messages not returned in a timely fashion.”
• One-third (33%) have hired new staff, one-quarter (28%) have increased hours for current staff, 19% have increased use of an “outside billing company,” and 16% have increased use of “collections agencies” in response to the narrowing of provider networks.

Just say no
Years of CMS member surveys and reams of studies of physician burnout point to a profession in crisis. Physicians prescribe medication or treatments and hope insurance companies will approve them. Then they fight to get paid for their work and face roadblocks and hassles at every turn, if they’re lucky enough not be rejected from a network or offered rates that force them out of business.

If approved, these mergers will only accelerate these trends, and put the survival of office-based, physician-owned practices in jeopardy. A decline in the number of independent voices standing up for the practice of medicine and for the rights of patients – including the humanity of medicine beyond dollars and red tape – will continue to degrade the trust between Colorado’s physicians and their patients, a trust that is imperative each time a new patient enters a doctor’s office for an initial examination.

Physicians are clear in their message today: Approving these mergers will harm care for Coloradans, and regulators should say no.

Methodology
This survey was conducted online by the Colorado Medical Society. It includes 597 fully completed surveys, including 153 interviews with decision-makers (those who are directly involved in contract negotiations). An additional 138 members partially completed a survey; these results are included in the tabulated results as well.

Questions were asked regarding both the Aetna-Humana merger and the Anthem-Cigna merger. Attitudes on these questions did not vary significantly between the two mergers; the data is presented for the Anthem-Cigna results.

Call to action: What Colorado physicians can do

1. Communicate your views on the mergers immediately by writing the state insurance commissioner, Marguerite Salazar. Send a copy of your letter to Colorado Gov. John Hickenlooper and Colorado Attorney General Cynthia Coffman.

Commissioner Marguerite Salazar
Division of Insurance, Colorado
Department of Regulatory Agencies
1560 Broadway, Ste 850
Denver, CO 80202

Governor John Hickenlooper
200 E Colfax, Room 136
Denver, CO 80203

Attorney General Cynthia Coffman
Colorado Department of Law
Ralph L. Carr Judicial Building
1300 Broadway, 10th Floor
Denver, CO 80203

2. The Colorado Division of Insurance will soon hold hearings on the proposed Anthem-Cigna merger. Email president@cms.org if you are interested in attending and possibly testifying on behalf of your practice. CMS will provide you with assistance.