BOG miniseminar: Otolaryngology managed care symposium

Abstract This miniseminar will present all sides of the issues with the proposed panel being comprised of both leading physicians and managed care executives. The audience will participate with interactive responses and active discussions from the floor. The panelist will review (1) the historical background of the health care industry; (2) a market analysis of the current state of managed care; (3) topics such as coding, timely claims payments, and bundling; (4) how decisions are made on new drug costs and technologies; (5) modification of coverage policies and carriers’ administrative costs; (6) partnering with carriers to decrease medical errors; (7) increases in MD reimbursements. A recent AMA study reported that last year there were growing concerns about the 11% increase in health insurance premiums. This fifth year of consecutive increases has outpaced both medical and overall inflation. Profit margins of health insurers have also been steadily rising despite a slowdown in the general economy. According to the 2001 Weiss Ratings, insurers experienced a 25% increase in profits between 2000 and 2001. In contrast, the role that physicians play in patient care, including legal and ethical obligations, is being undermined by having little leverage in negotiating contracts with health insurers. These contracts affect every aspect of the patient-physician relationship, including diminished revenues. Some of the proposed multi-district litigation settlements with managed care are unreasonable, benefiting mostly the attorneys, in comparison to the minimal financial benefit to class members. Given the scientific advances of modern medicine and the inequities of our health care delivery system, today’s physicians confront pressing challenges including providing appropriate care, rationing of expensive medical technologies, addressing potential financial conflicts of interest, and disclosing medical errors. At the same time, managed care utilization reports raised concerns about some physicians’ over utilization of services, unnecessary surgical recommendations, and inappropriate over coding. We are at a critical crossroad: a time when open dialogue between both sides could help define the future of medicine. By airing our concerns and coming up with workable solutions we would be taking a crucial step toward the common good.