Dr. Bricker: I would respectfully disagree with many of the statements and conclusions you have presented. I have negotiated hundreds of managed care contracts for Hospitals, Outpatient Centers, Physicians, and ancillary medical services, since 1993 (the advent of Managed Care in Texas). The Evergreen contract was put in the contracts by the insurance companies, not the providers. We would negotiate every year if it were possible. Especially since our governing boards request it. Secondly, the automatic increases you refer to is called an, "escalation clause". Good luck getting it put into a contract, and a bonus if you can get 6%. Does not happen. I can remember only getting an escalation clause built into an agreement on maybe 2 of the hundreds of contracts I have done. Never got 6%. In one of my markets, I was very fortunate to be the 900 lb. gorilla in the market. We were a 500+ Trauma Center, with a medical staff of close to 500. I negotiated on behalf of both of them, through a PHO (Physician Hospital Organization). Then and only then, with that kind of leverage can you dictate this kind of agreement and it was with the lesser players in the market, not Blue Cross, Aetna or United Healthcare. On another note, the time frame you presented 2013, as a huge increase in staff, was during the implementation of the Affordable Care Act (2010, fully enacted 2014). That played a major role in medical providers having to understand how to work within the legislation. It was a bad time for everyone involved. I appreciate much of what you present. Especially from the Medical perspective.
Dr. Bricker: I would respectfully disagree with many of the statements and conclusions you have presented. I have negotiated hundreds of managed care contracts for Hospitals, Outpatient Centers, Physicians, and ancillary medical services, since 1993 (the advent of Managed Care in Texas). The Evergreen contract was put in the contracts by the insurance companies, not the providers. We would negotiate every year if it were possible. Especially since our governing boards request it. Secondly, the automatic increases you refer to is called an, "escalation clause". Good luck getting it put into a contract, and a bonus if you can get 6%. Does not happen. I can remember only getting an escalation clause built into an agreement on maybe 2 of the hundreds of contracts I have done. Never got 6%. In one of my markets, I was very fortunate to be the 900 lb. gorilla in the market. We were a 500+ Trauma Center, with a medical staff of close to 500. I negotiated on behalf of both of them, through a PHO (Physician Hospital Organization). Then and only then, with that kind of leverage can you dictate this kind of agreement and it was with the lesser players in the market, not Blue Cross, Aetna or United Healthcare.
On another note, the time frame you presented 2013, as a huge increase in staff, was during the implementation of the Affordable Care Act (2010, fully enacted 2014). That played a major role in medical providers having to understand how to work within the legislation. It was a bad time for everyone involved.
I appreciate much of what you present. Especially from the Medical perspective.
Thank you for sharing your experience. Open to multiple perspectives.