Oh Doc ... You Want to Get Paid?

“Never confuse the size of your paycheck with the size of your talent.”

—Marlon Brando

It seems odd that someone would be happy that another person was in the hospital, but it happened around my house when I was growing up. It meant that my physician-dad was going to have a payday. “Your father’s in a better mood now, because a couple of his patients were just admitted to the hospital,” my mom would explain. That’s a doctor’s life.

I also know when he retired from medicine he was owed a lot of money by health insurance plans. I saw the figures—well into six figures. They stiffed him and he didn’t like them much. The more things change in medicine, it seems, the more they stay the same. Today’s physicians “broadly mistrust” health insurance companies and even say they “interfere with their ability to provide high-quality patient care.”

Leaving aside their recent burst of merger activity—another club with which to clobber America’s doctors?—there’s a new study of the attitudes and opinions of working physicians as they relate to national health insurance companies, The ReviveHealth 2015 National Survey of Physicians: Do They Trust Health Plans? It paints an unflattering picture.

Overall, physician trust in the nation’s largest health insurers is dismal — the average of all combined scores being about 58 out of 100. The prime yardstick being the firm’s ability to “enable the delivery of high-quality care.” This is slightly higher than the 52 that US hospital leaders gave insurers when they took the survey in 2014. Here some other points:

• 94% of physicians reported having contracts with their local Blue Cross Blue Shield plan, 90% with both Aetna and UnitedHealthcare, 82% work with Cigna, and 65% with Humana.

• Three categories were combined to create a “Trust Index.” Blue Cross Blue Shield had the highest overall score (60.5), followed by Cigna (58.6), and Aetna (58.2). Humana received the lowest trust score (56.5), followed by UnitedHealthcare (57.1) and Anthem/Wellpoint (57.6).

• On the matter of “Behavioral Reliability” (the organization’s effort to honor its commitments), Blue Cross Blue Shield and Cigna performed best with scores of 65.3 and 63, respectively. UnitedHealthcare and Humana performed worst with scores of 60.7.

• On the matter of “Honesty” (the organization’s accuracy and and honesty in representing itself and its intentions), Blue Cross Blue Shield and Cigna were tops at 61.5 and 60.1, respectively. Humana (at 58.6) and UnitedHealthcare and Anthem/Wellpoint (each at 58.8) were at the bottom.

• On the matter of “Fairness” (how the organization balances its interests with ours and doesn't routinely take advantage), Blue Cross Blue Shield won out at 54.6 and Humana performed worst at 50.2.

Problems yes, but is there an opportunity for improvement? When it came to the justifications for the “best” ratings, doctors said it’s about the people. While proper reimbursement always matters, top rankings were awarded to those payors with superior relationship-driven abilities—good customer service, organization, administration, and clear guidelines. “If only they would listen to the doctors,” my dad would say.