Now’s the time for docs to take the lead
Don’t wait for payers, government to act
Physicians have a good opportunity to have a major influence as the health care industry moves toward higher technology and the Internet, Lee Akay maintains. "Physicians now have a chance to take a leadership role, where in the past they have had inherent risks but not rewards," says Akay, managing partner for the Pricewaterhouse Coopers MCS Healthcare Practice in Pasadena, CA, which co-sponsored a recent survey on physicians and the use of the Internet.
Physicians who replied to the survey say they believe it will take action by the Health Care Financing Administration or other payers to require providers to use the Internet for claims processing and other administrative services. But Akay disagrees. "It’s important for physicians to participate in the leadership for a change rather than waiting for someone else to decide," he says.
Because of the consumer backlash against some insurance policies, payers are re-examining their network strategies, and many are moving from capitation to some preferred provider organization-type product. At the same time, payers are moving to standardize their electronic systems to comply with the Health Insurance Portability and Accountability Act (HIPAA). As HIPAA is implemented and payers develop network strategies, physicians have a good opportunity to come together and assume a leadership role, he says.
"On the provider side, leadership has been fragmented, and it’s been easy for payers to develop strategies to keep passing the risk to providers," Akay says. That’s why physicians have to take more of a role in the changes so they, too, can reap some of the rewards and avoid some of the risks. "As we use these Internet-enabled processes and technology, we need to decide how to fairly share the efficiencies and savings across the board so it all doesn’t go to one stakeholder," Akay says.
At the individual practice level, Akay suggests that physicians make sure any associations they belong to have representation equal to the payer side. "Physicians should encourage their leadership to unite around a common cause so they can be represented equally at the table," he says.
It will take a concerted effort and a large organization to make a difference, he says. "For instance, in California, some payers own 18% of the market. A single individual practice can’t go against that. That is where an association can play a role," he says.
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