Insurer Consolidation

Insurer monopolies should be among the most important topics discussed in emergency medicine, Jody Crane, MD, chief medical officer of TeamHealth, argued in a written statement to ACEP Now. TeamHealth is a large physician staffing and outsourcing company, with 14,000 affiliated physicians and advanced practice clinicians, including emergency physicians. “The root of many problems we experience today is insurer consolidation and [the] resulting lack of insurer accountability. The AAMC study shows that the scales are weighted heavily in favor of insurers such that there is little likelihood physicians can match them in any market,” he wrote.

“Today’s health care environment is largely driven by insurer monopolies that foster one-sided, take-it-or-leave-it rate-setting that reduces physician reimbursement. Insurer practices of unilaterally downcoding charges, denying care, and creating opaque payment schemes are harmful to all physicians across the country, especially smaller practices that lack the market leverage and resources necessary to fight back. This issue is especially acute for ACEP members because insurers have little incentive to maintain adequate networks; under EMTALA requirements, their participants always receive care,” Dr. Crane said.

TeamHealth has tried to fight back, including advocacy on many fronts and the successful litigation of unfair payment practices in a lawsuit against UnitedHealthcare following a 2017 mass shooting at a music festival in Las Vegas. On November 29, 2021, a Las Vegas jury found United guilty of “oppression, fraud and malice” for denying ED claims and ordered it to pay $60 million in damages to TeamHealth.⁵

Although we have a long-standing practice of not balance billing patients, we fight underpayments in the No Surprises Act’s Independent Dispute Resolution process … because we believe in fighting for what is fair,” Dr. Crane said, adding that neutral Independent Dispute Resolution arbiters have agreed with TeamHealth more than 90 percent of the time.

Is Bigger Better?

“Private equity is just a player in this game that we’ve created as a society, where everything gets bigger and bigger,” said ACEP’s President L. Anthony Cirillo, MD, FACEP, director of government affairs for the Canton, Ohio-based physician staffing firm US Acute Care Solutions. “The AAMC has put into print what has been the reality for years — even though this can be painful for our physicians to hear — that health care truly is a business. Whether we like it or not, there’s a lot of money involved, 18 or 19 percent of our gross national product.”