EDITOR'S PAGE

This Ax Swings One Way

by Rich Kirkner

This year's Managed Care Survival Kit spotlights doctors who have taken the ax to managed care.

It's hard to say if more of you are swinging this ax. Our own research shows the typical O.D. deals with fewer plans this year, seven vs. nine in 1998, but that the share of patients with third-party coverage is up about 25 percent.

Maybe you are getting smarter and tougher about dealing with insurance companies. Unfortunately, they're getting bigger and tougher, too, maybe at a faster pace. What's a doc to do?

Taking the ax to managed care is good medicine for some doctors, but swing carefully. As a profession optometry needs third-party payers, specifically medical plans, more than ever. That's fuel for the profession's ever-expanding primary care role.

Traditional vision plans may be easier to ax than you think, and that's not all bad. They're more likely to slash your margins on materials than medical plans.

Also, you need to join with other docs to tame the managed-care beast. First, however, you need some legislative help. Texas has already taken a step to give doctors limited rights to collectively bargain with HMOs. (See "Two States, Two Approaches to Fee Negotiation".)

The Quality Health-Care Coalition Act of 1999 would give doctors nationwide broad rights to negotiate with insurers. This bill has little chance of passing this year, but its mere introduction proves that insurers have seriously disrupted the patient-doctor relationship.

The AOA isn't supporting this bill, but should. The likes of the American Medical Association and Academy of Ophthalmology have come out for it.

Presciently, the AOA notes that this legislation could let provider groups get around antitrust laws. All the more reason for the AOA to get involved to ensure that it does not allow plans to keep O.D.s off their panels. The AOA must also realize that market forces are working against this kind of exclusion.

Specifically, ophthalmologists live on optometrists' referrals, especially for those lucrative refractive surgery patients. Besides, insurers would still have the bulk of the weight at the bargaining table, and they want all the names they can get for their panels. Excluding doctors isn't what they're about.

You might not be ready to take the ax to managed care, but the only way you can tame this beast is by joining with other doctors. Strength in numbers. That's what the managed-care animal understands.