Leslie
I think you are right on the mark with your comments on the insurance companies and your reticence to trust them. Their behavior is abhorrent and borders on criminal in many cases. It is typical that they will not publish a fee schedule, they let you take the risk, and let you know after the fact, what they will pay.
I am sure my numbers stink, except with respect to my high use of generic medications. My immediate goal is to use the power of this system to make me a better Doctor. I believe the cost savings will come directly with best practices AND with diligent collection of data to reduce duplication of efforts.
A solo practitioner is David and Goliath without the slingshot. You don't stand a chance against any insurance company, not even Medicare which is the least criminal.
Do you have "managed care" in your area in the same form that I do? That is, I belong to an Independant Physician Association (IPA) and it is the IPA that has contracts and negotiates with the insurance companies. The IPA sets the rate that will be reimbursed for the vaccine, and I know the amount up front. If one carrier, (Humana for example) won't pay well enough the IPA has the option of shifting business away from the plan. It is the IPA that has an army of marketing folks who go door to door preying on the elderly, No strike that, who go door to door helping the elderly to select the best insurance product for their needs. They will move away from a carrier that doesn't reimburse well enough to cover costs. It is the IPA that I believe I will be able to negotiate with. If I do have the quality of practice and good outcomes, that are also cheap enough, and I find the IPA is not willing to reward this effort then I will walk. There are at least 8 IPA's in my immediate area. It is my understanding that HMO insurance has not made anywhere near the impact in the midwest that we suffer here on the coast.
