Please share your stories here on how corporate interventions in medicine have impacted you and your practice. This includes private equity acquisitions, noncompete agreements, management service organizations, and any business intervention that has impacted your ability to practice medicine.
I’ve seen family physicians’ work transformed from a full diagnostic and treatment service, advocating for patients through healing relationships available in any location for anyone in need to that of a scripted algorithmic automaton entering orders like a fast food order entry clerk meant to refer every problem that takes a little thought or time-intensive action to a higher copay level of care. We know how to keep people out of the ED snd hospital when it isn’t necessary to be there so that knowledge and autonomy had to be neutralized. It wouldn’t be so demoralizing if we could actually use our training to practice real medicine. Instead the majority of our effort must be aimed at removing obstacles insurance companies place to avoid paying for things patients’ need. Or if we could blind ourselves to the legalized fraud inherent in the government backed “value-based”, cost-saving” programs managed by the commercial payers who established exclusive networks that cut out independent practices and whose every profit is ultimately paid by taxpayers who have no real choice in where or how we receive medical care. Take this for example:
Retirees in NYC have litigation underway to protect access to traditional Medicare after they have seen the way beneficiaries of retirement plans are forced into Medicare Advantage plans over traditional Medicare. That is the route, in Medicare, and as MCOs in state Medicaid plans, through which insurance corporations came to represent enough lives to get control of the healthcare market to set prices. Then they pull their grifts among their small group of vertically organized corporations to lower their own costs while they pass higher costs on to consumers. (See the expose of MultiPlan by Chris Hamby in the NYT) The same government that can’t discern private equity pirates from trained and licensed physicians in practices they own or locally controlled charitable hospices hands our earnings in the Medicare Trust to this same set of MAP-ia thugs.
You might as well get the pharmacists at locally-owned businesses to chime in because now the same things are happening to them. PBMs clawing back their payments to be a net loss on drugs dispensed that they purchased from suppliers in the same vertical chain as the PBM. Five-Star drug penalties, whether patients are adherent or not, and use of false and unquestioned data to make them appear non-adherent when they are. Here’s another example of “value based” objectives twisted to hurt small businesses:
A retired nurse with Htn, uncontrolled at a visit while she was pending carotid endarterectomy and had other stressors–I wrote valsartan to give flexibility to take 1 or 2 per day depending on her levels in checks at home. She got through the surgery well, has stopped smoking after that and is prepared for knee surgery that causes chronic pain. Other social stressors improved. Only needs 1 valsartan every day and is taking it, but shows up as non-adherent because her Rx is for #60 and it has been filled monthly whether she was out of it yet or not. She called me upset that her pharmacist called to tell her he couldn’t afford to fill that rx for her anymore. She had chosen that pharmacy because it was in distance her disabled grandson could reach on his scooter during a time they didn’t have a car during and after the pandemic.
So at the micro level, this is exactly what we want our efforts to produce for patient outcomes. And how much does valsartan cost to allow that flexibility? She is still in a vulnerable position and stressors could return, she might start smoking again. At the population level, this is something to twist around, apply a penalty to a pharmacy on a “Star” medication and force the rx to go to mail order owned by the insurer. And even if all of the customers at that pharmacy on that insurer were a five star adherent patient, the insurance would still take 3% back! It’s all coercive to funnel a patient to mail order or a CVS.
Independent practices snd pharmacies cant negotiate contracts to get fair prices because we’re “too small”. Independent practices and local nonprofit hospices consolidated into larger corporate groups for security and bargaining power. Pharmacies must trust their PSAO to negotiate for them. But all of those groups funnel down through an intricate web of ownership/partnership to a handful of executives at pharmacy snd insurance corporations.
Consider the hack on UHC and trace those purchases and mergers that led to that lapse in security. Skipped the simple multiple factor authentication that we have to do on every single controlled substance rx! Look at who now controls the familiar names in medical and pharmacy supplies.
Screw them! is all that can be said.