Medical care now more about money than medicine

When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills by Rachana Pradhan – Feb 2020

This is a sad tale of how our medical care has become more about money than medicine, thanks to the financial “interests” who have bought up all the hospitals and doctors.

When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser … her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.

This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.

As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.

But it’s not actually doctors that are getting more money, but their overlords, the financiers who are profiteering from the declining health of American citizens.

As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.

The money is flowing upward in the org charts to the rapacious financial folks who own doctors, hospitals, and insurers.

Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.

Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement.

But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients.

In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.

The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.

Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.

“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”

Doctors say they are taking the brunt of the criticism.

…even though their “managers” who have bought their practices and now own them are the ones getting all this money.

But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.

They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections.

It’s not the actual doctors doing this – they are far too busy seeing hundreds of patients (or at least patients’ medical charts) to make any political efforts.

Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the

  • American College of Emergency Physicians,
  • Envision Healthcare,
  • US Acute Care Solutions and
  • U.S. Anesthesia Partners —

gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.

That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.

So this is a fight between the financiers who own stables of doctors versus those who run insurance companies. Both individual doctors and patients suffer the collateral damages of these epic battles between the titans of finance.

“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”

Arguing Over The Fix

Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.

Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill.

One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies.

Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking.

Large employers, labor unions and insurance companies prefer this.

The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines.

Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.

Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.

Pak-Teng is clearly not a “doctor” anymore, but rather a tool of the profiteers.

“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.

The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.

“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.

Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.

In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.

He’s another one who is no longer really a doctor, but has become a tool of the financial industry.

Tilt Toward Doctors

Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful health care committees was already tilting to be more favorable to doctors.

“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”

Sadly, there is no longer much difference between the moneyed interests of the insurers and the moneyed concerns of the groups that own our doctors these days.

In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.

By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.

“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.

I’m disgusted that all the doctors fighting for “fairness” are owned by private equity groups whose only goal is to extract as much money as possible from our medical care.

Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.

In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.

Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.

Who are all these doctors with so much spare time they can make lobbying trips? The ones who are treating patients don’t have time for such activities.

“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”

By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.

Every person involved in this fight seems to be owned by or beholden to the profiteers.

Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.

“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”

In that case, they should legislate against private equity being allowed to own any piece of our medical care. That’s the only reasonable solution that I can see.

Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.

“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.

What’s Coming

Arvind Venkat, a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania.

Again, it’s private equity that’s paying him to make these trips. He would otherwise be in his practice seeing patients and practicing medicine instead of lobbying.

But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.

“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.

Too late for that. None of this fight is about patients – it’s all about the profiteers backing doctors versus those backing insurance companies.

The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.

Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state’s health care system.

“The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks.

He’s only complaining about the “heavy hand of government” when it doesn’t benefit his “side” in the fight.

The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.

“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview.

We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.

When these guys start talking about “fairness” and “balance”, it only means they want more of the money.

Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.

“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”

B.S. – he’s worried about how much money is going to the financial groups that pay for and own him.

2 thoughts on “Medical care now more about money than medicine

  1. Kathy C

    The system is just much too corrupt. Even if they did find a way to stop the “surprise medical bills” the industry would come up with another scheme. The ACA was peddled to us, as a way to get accountability, yet there is even less accountability than there was 20 years ago. The for profit medicine promoters and propagandists, pushed the false idea of “choice” or “comparing prices” as a way to bring down costs, we saws how well that worked out. Groups set up websites, yet there was no cost data. They used the data from CMS on 7 procedures, the only ones they gather any cost data on. Of course these had no basis in reality, and certainly had no correlation with the prices that patients are actually charged in real time.

    We saw the years of wasted time, as corporate lobbyists, and industry interests had their way with the ACA. Industry funded politicians argued for their funders pieces of the share of billions in healthcare dollars of , while the misinformation and lies and patients were fed industry talking points through nefarious patient groups. The costs went up and outcomes got worse. All of the indicators tell us that the system is failing, the infant and maternal death rate, the number of uninsured, and even the number of suicides, all tell us that our healthcare system is failing.

    They waste massive amounts of time and resources, finding stop gap measures to reign in one aspect of industry corruption. The laws are not enforced or they have been done away with, leaving the industry to get way with “surprise medical bills,” price gouging, data manipulation, and misleading “consumers.” The word “consumer” is an indicator of how bad it is. This country used to have laws and regulations to protect patients, but for consumers it is buyer beware. People with serious medical situations cannot “shop around” even if they could, the data is so limited there is no way they could make and informed decision.

    For years they peddled lies about the EHR, it was supposed to provide “solutions” instead the industry chose what data they would allow to be collected. The EHR was not comparable with other record systems. Physicians wasted time that was supposed to be spent with patients, doing clerical work, instead of caring for patients. The big tech companies, and various industry interest found new and clever ways to mine the data, not for the benefit of patients but to sell to the industries to find new ways to profit from it. They even monitored patient groups and online communications to create counter narratives to protect their profits, and provide false narratives for propaganda and marketing campaigns.

    Using the so called opioid epidemic as a starting point,, it is easy to see the patterns. We can see how they misuse data, spread lies and propaganda, that protect industry profits. The record of Perdue’s misinformation campaign, to go along with deregulation, along with the drive for profit at any cost, killed Americans, and there was no meaningful regulatory action. Industry propagandists, misguided uninformed individuals, and marketers, all spread their lies and opinions in the media. Because they were all in the pocket of various industries, not one discussed the deregulation of marketing, regulatory capture, and the industry insiders at regulatory agencies. It took over 20 years for a response to the misleading marketing of opioids, in meantime people are still dying, because of ignorance and misleading data.

    Medical marketing used to be highly regulated, now anybody can get online, or publish and advertorial, or lies and propaganda, that appears to be journalism. The FDA has relaxed even more regulations on pharmaceutical safety, at the request of industry insiders. The FTC has been underfunded, understaffed, and no longer enforces basic laws, and regulations. There were no criminal charges for surprise medial bills, or any of the other schemes these industries use to increase profits. The pharmaceutical distributors, and corporations that got caught a decade ago, selling black market opiates, got a slap on the wrist. Perdue’s propaganda campaign, chose to target patients and physicians, for law enforcement, instead of the big corporations.

    The industry will continue these schemes, surprise medical bills, misreporting data, and conning the public, as long as there are no criminal penalties. They lied about “transparency” and they have plenty of propagandists, and paid off politicians protecting them. Around 20% of GDP goes to healthcare, and the costs keep going up. A good percentage of this money goes to clever propagandists, paying academic institutions for research, and paying off our politicians. Tracking the lies and propaganda around Medicare For All, shows how much power the industry has. Even if they get rid of surprise medical billing, or lower the costs of prescription drugs, none of this will have a meaningful impact, until we start criminalizing these white collar crimes. We also need to limit the advertising and marketing especially when peoples lives are at stake.

    Here is another article about how deceptive the data really is. The rates of infant and maternal deaths, are a key indicator on the function of a healthcare system. It is no accident these data points were not collected, and the incidence of deaths were misreported, the facts are bad for profits. The only source of information people have is media marketing, and word of mouth. the healthcare industry does not want factual data collected, it could cost them. When this data came out in mass media, it was bad enough, though under reported. It took only days for clever industry brainwashed journalists/marketers to amplify articles about one medical provider and how wonderful they are for minority mothers to be. Articles like this are done to offset the facts. They use a salient exemplar or patient testimonial, to give the public the false idea that this is not happening in their community, or it wont happen to them. This is the same pattern of misinformation they did with the so called opioid epidemic. Health marketers came out with a marketing campaign, to downplay the problem of maternal infant mortality.

    In my community health providers regularly double bill vulnerable seniors. The bill Medicare, but they send a confusing misleading bill to the patient. There is no way to tell how many of these bills were paid by Medicare, and then the patient. No patient has ever to my knowledge gotten a refund. Often they don’t believe they do not have to pay the bill. These are people on limited incomes, who have to do without if they pay it. The industry continues this deceptive practice, and made the bills even more confusing. Senior organizations like the industry funded AARP, are helping these big corporations get away with these tactics, gaslighting the public is profitable. State agencies have not protected anyone from any of these deceptive practices, they only exist to protect the industry.

    Liked by 1 person

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