It can be difficult for small physician groups to take on large insurance companies over payment and contract issues even if the law is on the physicians’ side. Lawsuits are often long and expensive, with no guarantee of success, and individual physicians or small groups frequently lack the resources to pursue costly court cases.
California’s emergency physicians have an ally in the fight for fair reimbursement: the physician-lawyer duo of Irv Edwards, MD, FACEP, and Andrew Selesnick, JD. The pair have been advocating for fair and proper payments for emergency physicians for about 20 years. They recently celebrated a victory in a case argued before the Supreme Court of California that could make it easier for physicians to collect fees they are owed by independent practice associations (IPAs).
Dr. Edwards is a board-certified residency-trained emergency physician who established southern California-based Emergent Medical Associates 25 years ago and is currently its president. Mr. Selesnick was a partner in the firm Michelman & Robinson and head of the firm’s health care department during the Supreme Court of California case. He recently joined Buchalter, a law firm based in Los Angeles.
They both recently sat down with ACEP Now Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, to discuss their recent court win and their long-term mission of fighting for fair compensation for emergency medicine services.
KK: You two have had a long history of supporting emergency physicians and pursuing emergency physician reimbursement when things have been unfair. Can you give us a sense of the history of what you have done and those you’ve pursued over the years?
IE: I was the president of California ACEP, and much of my desire to see the tables of justice set properly occurred when I met with the president of Health Net many years ago while seeking a contract that would be statewide that set fair reimbursement rights. He honestly said to me in his condescending way, “Son, ‘fair’ isn’t part of our negotiating strategy.” Andy, at that point, became my partner. We spent a lot of time looking at laws in the state of California, and it wasn’t really very hard to figure out, in many regards, how the rights of emergency physicians were being trampled. People were almost daring you to say, “you can sue us, but we’re not going to pay you what the law says.” I do think that it is somewhat difficult for smaller independent groups to pursue such litigation because, in many regards, it is undoubtedly expensive. Certainly, the cost of pursuing legal recourse can be greater than the economic recovery. That’s what the health plans bank on.