Saying no to insurance contracts is only way for urologists to gain leverage

I read the last paragraph of your December 2011 Perspective editorial ("Economic issues have far-reaching effects," page 4) with great interest. It ended with, "Now if someone could figure out how to translate 'supply and demand' into increased revenue, we could capitalize on the shortage of urologists and the huge demand for our services."

Some of us figured it out when Medicare and commercial insurers made us figure it out. When our practices lost considerable reimbursement for luteinizing hormone-releasing hormone agonists and Blue Cross and Blue Shield "negotiated" us down to 110% of Medicare rates, that was the end of it. It was a simple financial decision to decide to drop out of insurance networks.

I can't speak for everybody in every part of the country, but when I refused to sign contracts (which came with no attached fee schedule), my income doubled. There may be an impending shortage of urologists, but the law of supply and demand doesn't work if every last physician blindly accepts insurers' contract rates. The only way to effect a change in reimbursement is to leave the insurance companies and then, if you desire, negotiate rates to get back in. Negotiating rates while still "participating in the plan" lets them know you need their patients and is a position of weakness.

Dr. Gee responds:
I thank Dr. Margolis for his comments. You are correct; one of the most effective ways to fight continuing cuts in reimbursement is to "just say no" to payers that do not offer a clear contract with rates that physicians feel are reasonable. This will not work for everyone and will depend on the payer mix in a particular geographic area and the access to urologists in that area.

A number of years ago, a urologist in Michigan completely dropped all of his insurance contracts and also dropped out of Medicare and survived ("Urologist's bold move takes him off Medicare's radar," Urology Times, Sept. 2002). If the coming changes in the current health care reform legislation erode the physician fee schedule much further, we will see practices start to opt out of Medicare as well.

William F. Gee, MD
Lexington, KY