We Should Wage War on the Insurance Companies

[bikERdoc]

Sorry to incite violence, but it's true.

This year while front line healthcare workers continue to put themselves and family members at risk in order to care for the sick, insurance companies are posting record profits. UnitedHealth revealed earnings of $5 billion dollars during the first quarter of 2020. Up 3.4% from the same quarter last year (UnitedHealth Reports Profit, Citing Falling Demand for Elective Care). Americans continue to pay their premiums, while ED visits plummet and elective procedures have been put on hold amidst the pandemic. Insurance companies are BANKING off of coronavirus.

At what point do we say enough is enough? How long are ED docs going to continue showing up for work with reimbursements declining? Executives and shareholders of these insurance companies are about to have one of their best years on record, while frontline healthcare workers see hours cut and rate drops. Not to mention those of us who are literally dying from covid-19 infection. At what point is it not worth doing the job?

I feel like now is the time to start TV ads, write up news articles, and spread the public word about what insurance companies have been doing. It's time to ramp up the conversations about balance billing, refusal to pay bills, and general tactics that insurance companies have been implementing. The AMA and EM PACs should be lobbying hard for some kind of change.

I love EM but I wouldn't do it for free.

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[deleted547339]

Sorry to incite violence, but it's true.

This year while front line healthcare workers continue to put themselves and family members at risk in order to care for the sick, insurance companies are posting record profits. UnitedHealth revealed earnings of $5 billion dollars during the first quarter of 2020. Up 3.4% from the same quarter last year (UnitedHealth Reports Profit, Citing Falling Demand for Elective Care). Americans continue to pay their premiums, while ED visits plummet and elective procedures have been put on hold amidst the pandemic. Insurance companies are BANKING off of coronavirus.

At what point do we say enough is enough? How long are ED docs going to continue showing up for work with reimbursements declining? Executives and shareholders of these insurance companies are about to have one of their best years on record, while frontline healthcare workers see hours cut and rate drops. Not to mention those of us who are literally dying from covid-19 infection. At what point is it not worth doing the job?

I feel like now is the time to start TV ads, write up news articles, and spread the public word about what insurance companies have been doing. It's time to ramp up the conversations about balance billing, refusal to pay bills, and general tactics that insurance companies have been implementing. The AMA and EM PACs should be lobbying hard for some kind of change.

I love EM but I wouldn't do it for free.

Your comments sound like those of a Marxist. Companies making money isn’t evil, it how our society works. There are lots of reasons to hate insurance companies, but your argument isn’t one of them.

 

[GeneralVeers]

I think we should have the magic genie grant us 3 wishes....

 

[RustedFox]

I'm inclined to agree with the OP.
The insurers make their money off of not living up to their end of the bargain via delaying, denying or other less-than-fair practices.
Especially when premiums are sky-high.

 

[bikERdoc]

Your comments sound like those of a Marxist. Companies making money isn’t evil, it how our society works. There are lots of reasons to hate insurance companies, but your argument isn’t one of them.

I disagree but whatever. I'm actually a fan of free markets, just have issues with companies profiting off of denying claims and painting doctors as the enemy.

The title of this thread is probably a misnomer. We're already at war with the insurance companies. I should've said it's time to ramp up our troops instead. Just go to the political talks at your next EM conference. Insurance companies have gone to the trenches already and we should be doing the same with public voice.

Balance billing will be our next battle ground. We will never have as much political clout as we do right know in the midst a pandemic literally killing EM doctors. I think it's a great time to be ramping up our efforts to protect our livelihoods.

 

[Mad Jack]

Sorry to incite violence, but it's true.

This year while front line healthcare workers continue to put themselves and family members at risk in order to care for the sick, insurance companies are posting record profits. UnitedHealth revealed earnings of $5 billion dollars during the first quarter of 2020. Up 3.4% from the same quarter last year (UnitedHealth Reports Profit, Citing Falling Demand for Elective Care). Americans continue to pay their premiums, while ED visits plummet and elective procedures have been put on hold amidst the pandemic. Insurance companies are BANKING off of coronavirus.

At what point do we say enough is enough? How long are ED docs going to continue showing up for work with reimbursements declining? Executives and shareholders of these insurance companies are about to have one of their best years on record, while frontline healthcare workers see hours cut and rate drops. Not to mention those of us who are literally dying from covid-19 infection. At what point is it not worth doing the job?

I feel like now is the time to start TV ads, write up news articles, and spread the public word about what insurance companies have been doing. It's time to ramp up the conversations about balance billing, refusal to pay bills, and general tactics that insurance companies have been implementing. The AMA and EM PACs should be lobbying hard for some kind of change.

I love EM but I wouldn't do it for free.

I think your first war should be against CMGs, as they bleed you dry far more than insurers

 

[bikERdoc]

I think your first war should be against CMGs, as they bleed you dry far more than insurers

True. I'll let you start that thread

 

[docB]

Balance billing will be our next battle ground. We will never have as much political clout as we do right know in the midst a pandemic literally killing EM doctors. I think it's a great time to be ramping up our efforts to protect our livelihoods.

You are correct that balance billing will likely be our next battle although it's not likely to be much of a battle. We will lose on balance billing. The question is when rather than if and what kind of deal will we get in the post BB environment. If we get no deal it will be very bad for us.

There's no politically viable way to support BB. The public already think that healthcare costs too much. They think doctor pay is a big part of that. They think that doctor's make too much already. The reasons why we need balance billing, because otherwise we have no bargaining leverage with insurers, are too complicated to have the average person understand.

We may have lost it already:

Kaiser Heath article points out DHS may have already ended balanced billing

 

[alpinism]

The fact of the matter is that health insurance is supposed to be for rare and catastrophic events not basic health care.

 

[RustedFox]

The fact of the matter is that health insurance is supposed to be for rare and catastrophic events not basic health care.

BUMP.

So much this.
You can have the choice to see or not to see a doc for the simple and routine things.
If I recall correctly, it was the insurers who decided that all visits come thru their eyes for post-hoc approval, in an attempt to fleece money off of the small things.

And the small things tuned into big things, given the lack of pre-emptive care.

And the Big Things, they did want to govern and deny, so they could make money for their stockholders.

Yep.

We need to wage war on the insurers. Make them play ball.

 

[Torsion]

You are correct that balance billing will likely be our next battle although it's not likely to be much of a battle. We will lose on balance billing. The question is when rather than if and what kind of deal will we get in the post BB environment. If we get no deal it will be very bad for us.

There's no politically viable way to support BB. The public already think that healthcare costs too much. They think doctor pay is a big part of that. They think that doctor's make too much already. The reasons why we need balance billing, because otherwise we have no bargaining leverage with insurers, are too complicated to have the average person understand.

We may have lost it already:

Kaiser Heath article points out DHS may have already ended balanced billing

New York State has arbitration style balance billing legislation that is working well. Virginia almost passed a provider favorable bill with arbitration this legislative season after defeating the insurance-backed legislation. Other states may have done the same but I'm not as familiar. There was a provider friendly bill in play at the federal level before COVID threw everything off the rails. Respect for emergency physicians is probably at an all time high currently. I think the idea that the profession has already lost on this is rather defeatist and probably not correct. I think our perception of what the lay public thinks about "rich doctors" or whatever isn't entirely relevant. We do not live in a direct democracy. What matters most is lobbying state and federal representatives and explaining the situation clearly. I'd say recent evidence says we can win on this issue.

 

[bronx43]

New York State has arbitration style balance billing legislation that is working well. Virginia almost passed a provider favorable bill with arbitration this legislative season after defeating the insurance-backed legislation. Other states may have done the same but I'm not as familiar. There was a provider friendly bill in play at the federal level before COVID threw everything off the rails. Respect for emergency physicians is probably at an all time high currently. I think the idea that the profession has already lost on this is rather defeatist and probably not correct. I think our perception of what the lay public thinks about "rich doctors" or whatever isn't entirely relevant. We do not live in a direct democracy. What matters most is lobbying state and federal representatives and explaining the situation clearly. I'd say recent evidence says we can win on this issue.

Anything that happened before COVID is entirely irrelevant at this point. We are about to see unemployment hit 30M soon. Balance billing and 20+% unemployment do not mix.

 

[Torsion]

Anything that happened before COVID is entirely irrelevant at this point. We are about to see unemployment hit 30M soon. Balance billing and 20+% unemployment do not mix.

People who are currently unemployed probably aren't likely to have health insurance to balance bill against anyway. Both the insurance lobby and our own has the goal of eliminating balance billing in protection of patients. I don't think any EP actually enjoys sending someone a whopping bill because their insurer doesn't want to pay up. The key is legislation that both takes the patient out of the equation and also ensures against government rate setting. These solutions exist in certain states already and have been successful. Representatives at the state and federal level have taken up the mantle in support of provider friendly solutions. Conceding defeat on this would be way premature.

 

[deleted547339]

Anything that happened before COVID is entirely irrelevant at this point. We are about to see unemployment hit 30M soon. Balance billing and 20+% unemployment do not mix.

Maybe in a rational world, but Washington is not rationale and the public has never been more empathetic towards us.

 

[EctopicFetus]

First the current health insurance market is not a free market. Second fighting the health insurers is a losing battle. Before Envision imploded it was worth about $5B.. United Health care is worth over 50x that. Throw in BCBS, Aetna, Cigna/CVS and you can see.. its like a mosquito landing on an elephant. If we can get the whole house of medicine on board that is one thing. But we cant even agree on basic stuff.

For those who rail against the insurers and I am not one to defend them they often pay 2-4x medicare. Now I know they play a major role in medicare and medicaid as well but those rates are set by the feds.

Yes their business practices are shady and they are generally ****ty people but all that is only because our laws and regulations allow that behavior.

 

[DocEspana]

If we go to war, I'm bringing a chest tube on a trochar as my weapon of choice.

It doesnt matter where I stab them... I just slide the tube into whatever wound I make and expedite the exsanguination. I'm ready for war.

 

[thegenius]

I love using chest tubes with trochars….makes introducing the tube so much easier. I recommend slightly bending them too prior to putting in the tube.

 

[bravotwozero]

Those trochars are usually too thick to bend, no?

 

[thegenius]

You can bend them a little. Like 15-20 degrees. Just hold either side like you are bending a stick and you can bend it a little. Our trauma surgeon showed me that trick and it makes it a little easier to direct it where you want it to go.

The other thing is once you enter the thoracic cavity, you have to pull the trocar back a little because it's very pointy and it will damage intra-thoracic structures very easily.

 

[southerndoc]

The other thing is once you enter the thoracic cavity, you have to pull the trocar back a little because it's very pointy and it will damage intra-thoracic structures very easily.

Like the right ventricle. It makes for a really bad day when that happens. I know of a case where it did.

Sharp-tipped trocars have a 15-40% complication rate. I will never teach a resident to use one. Can you imagine teaching residents to do IJ's if there was a 15% carotid artery injury or subclavian CVL's with a 15% pneumothorax rate? Trocars are dangerous, and the consequences of their use in an unskilled operator's hands is often life-threatening or deadly. I would not recommend their use.

I realize DocEspana was advocating their use to inflict complications to the insurance industry.

 

[thegenius]

Not my experience, but OK

 

[KGflyboy]

I'm not even sure I have access to chest tubes with trocars right now. I haven't seen one in the ED lately, and I've never seen one used in the ED. They look pretty slick, but I do suspect they come with a complication rate I'm not comfortable with considering I was never taught to use the. I simply don't have the experience with them to try it now for funsies.

 

[Birdstrike]

I agree with the OP completely. However, the problem with "waging war" with the insurance companies without a really careful strategy, is that they can respond with, "Okay then, ---k you. We're not paying you. Bye." Game on.

It's sort of like giving the middle finger to your boss everyday you show up to work. Yeah, you can do it, and yeah he probably deserves it, but you've got to have a little bit better of strategy than that. Otherwise you're gonna screwing the pooch.

Something you can't ever forget about evil, awful, terrible insurance companies is that we're married to them.

 

[deleted547339]

Something you can't ever forget about evil, awful, terrible insurance companies is that we're married to them.

And they have a helluva prenup.

 

[deleted547339]

Like the right ventricle. It makes for a really bad day when that happens. I know of a case where it did.

Sharp-tipped trocars have a 15-40% complication rate. I will never teach a resident to use one. Can you imagine teaching residents to do IJ's if there was a 15% carotid artery injury or subclavian CVL's with a 15% pneumothorax rate? Trocars are dangerous, and the consequences of their use in an unskilled operator's hands is often life-threatening or deadly. I would not recommend their use.

I realize DocEspana was advocating their use to inflict complications to the insurance industry.

Yea, they scare me. Honestly, I’m even a little leery of the seldinger ones for fear of the needle tip/guide wire going somewhere untoward.

 

[southerndoc]

Looks like our poor insurance companies are getting $12 billion from the US Government:

Supreme Court says Congress must pay insurers billions under ObamaCare

The Supreme Court on Monday ruled that Congress must keep its promise to insurers over a $12 billion pledge under ObamaCare.

thehill.com

 

[Dr Mantis Toboggan]

I love the pigtails for simple pneumothorax. Would way rather have one of those than one placed by traditional open technique tube personally (obviously not good for blood). This kit is my jam.

Products - Cook Medical

After percutaneous insertion via the Seldinger technique, the pigtail catheter of the Fuhrman Pleural Drainage Set serves as a conduit to drain air or fluid from the pleural space to outside the body. | Fuhrman Pleural/Pneumopericardial Drainage Set and Tray

www.cookmedical.com

Yea, they scare me. Honestly, I’m even a little leery of the seldinger ones for fear of the needle tip/guide wire going somewhere untoward.

 

[RustedFox]

Looks like our poor insurance companies are getting $12 billion from the US Government:

Supreme Court says Congress must pay insurers billions under ObamaCare

The Supreme Court on Monday ruled that Congress must keep its promise to insurers over a $12 billion pledge under ObamaCare.

thehill.com

Yet another example of well-intentioned money going to the wrong people.

 

[Apollyon]

Yet another example of well-intentioned money going to the wrong people.

C'mon, dude - this is an exemplar of the American solution to ANY problem: throw money at it!

(Yes, I used a snobby word.)

 

[NITRAS]

C'mon, dude - this is an exemplar of the American solution to ANY problem: throw money at it!

(Yes, I used a snobby word.)

People are very liberal with throwing other people’s money at their problems.

 

[Apollyon]

People are very liberal with throwing other people’s money at their problems.

Exactly!

 

[thegenius]

People are very liberal with throwing other people’s money at their problems.

Right.

That is the entire problem with the US Health Care System. The vast majority of what we spend is other people's money.

Why should these "other people" (a.k.a federal government Medicare, and insurance companies) just willy nilly go along with paying all the bills and not questioning them?

As much as I find insurance companies behavior appalling, it makes total sense to me.

I wonder if things would work a little better if they were highly regulated entities like utilities companies. For instance make them pay like 90% of all money to those insured, another 7% for administrative costs, and the remaining 3% can be profit.

 

[DocEspana]

Like the right ventricle. It makes for a really bad day when that happens. I know of a case where it did.

Sharp-tipped trocars have a 15-40% complication rate. I will never teach a resident to use one. Can you imagine teaching residents to do IJ's if there was a 15% carotid artery injury or subclavian CVL's with a 15% pneumothorax rate? Trocars are dangerous, and the consequences of their use in an unskilled operator's hands is often life-threatening or deadly. I would not recommend their use.

I realize DocEspana was advocating their use to inflict complications to the insurance industry.

I intend to cause MUCH more than a 40% complication rate on them.

 

[turkeyjerky]

Like the right ventricle. It makes for a really bad day when that happens. I know of a case where it did.

Sharp-tipped trocars have a 15-40% complication rate. I will never teach a resident to use one. Can you imagine teaching residents to do IJ's if there was a 15% carotid artery injury or subclavian CVL's with a 15% pneumothorax rate? Trocars are dangerous, and the consequences of their use in an unskilled operator's hands is often life-threatening or deadly. I would not recommend their use.

I realize DocEspana was advocating their use to inflict complications to the insurance industry.

Same. The only training I ever got on the trocar kits was "don't use em". Surgical or seldinger. It does seem like most hospitals still stock them though.

 

[TooMuchResearch]

Same. The only training I ever got on the trocar kits was "don't use em". Surgical or seldinger. It does seem like most hospitals still stock them though.

I didn't even know they exist. I guess my residency was ultra sleek, ultra modern.

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