Image Makeover

Rick Johnson, for HealthLeaders News , June 7, 2007

I'm excited to write my first weekly column for PhysicianLeaders. What was once a daily collection of news links is now a weekly e-newsletter that includes original reporting, guest features, audio interviews, and links to articles from HealthLeaders magazine and our monthly newsletters.

Since you're receiving this today, you probably were a subscriber of the PhysicianLeaders Daily News e-zine. Don't worry. We will continue to aggregate the top news items that most impact physicians and administrators. But I hope you find some interesting things to think about in our new features. For instance, this week frequent HealthLeaders Media contributor Scott MacStravic, PhD, considers the physician's role in behavioral medicine.

As a reader, you too can contribute your thoughts about physician leadership and the business of healthcare. Whether you want to write a feature or just share your opinion, feel free to email me directly.A few of the topics I hope to cover in this space include how physician practices are competing with retail clinics, the continuing trend of subspecialization, the physician side of "physician-hospital relations," physician compensation, and the strategies physician practices implement to become more effective and efficient businesses.

I personally find physician practice management and physician leadership to be as fascinating as they are complex. In this week's audio feature, my colleague Elyas Bakhtiari talks with Jeffry A. Peters, about how physician practices can negotiate profitable payer contracts. Peters, president and CEO of Health Directions, says that successfully negotiating managed care contracts could increase rates by 10 to 20 percent.

Getting paid what they deserve for their work seems to be a running theme for physicians nowadays. It reminds me of a story I wrote for a recent issue of HealthLeaders. I talked with Robert Monteiro, MD, board certified in internal medicine for 11 years, about how Blue Cross and Blue Shield of North Carolina was planning to contract with a radiology management company. Monteiro, who practices with Eastern Carolina Internal Medicine, a 40-physician group practice headquartered in Pollocksville, served on an advisory group that gave feedback to Blue Cross about the preauthorization project.

Blue Cross said it was reacting to a 21 percent increase in diagnostic imaging services from 2003 to 2005. The payer promised physicians the program would limit their administrative burden as much as possible by using Web-based technology, and officials have told Monteiro that the radiology management company approves 70 percent of the orders up front and typically responds in less than five minutes.

Despite all of this, Monteiro and other physicians were concerned that this program would amount to additional hassles and disrupt the physician-patient relationship. "The physician-patient relationship is becoming more adversarial because we have all of these other people in the room with us," Monteiro told me. "We have these insurers and lawyers in the room with us, and they really shouldn't be there."

No doubt the proliferation of imaging equipment--and the reimbursement for it--has led to an influx of physicians ordering these tests, just as Blue Cross claims. But perhaps it's because I cover physicians more than insurers that I find myself sympathetic to Monteiro's comments. As a consumer of healthcare, I also dislike the micromanagement of medicine. Most consumers see technology advances in healthcare as a good thing, and if my physician says I need an MRI to determine my condition, I certainly want one.

As always, the $20,000 question is, "Who's going to pay for this?"And more and more, payers and employers are responding, "Not me." Well, maybe in this case Blue Cross is saying, "Not all of the time."

Rick Johnson is senior online editor with HealthLeaders Media. He can be reached at

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