If revenge is a dish best served cold, why are so many focused on instant gratification?
I was talking with a friend in the medical billing business about laws pertaining to out of network billing by physicians, “surprise medical bills,” they’re called. In the classic sense, Mr. Smith has surgery from an in-network surgeon at an in-network hospital, but the anesthesiologist is out of network. Mr. Smith is then “surprised” when his carrier pays the anesthesiologist 2 cents, and he must pay the rest of the full usual and customary anesthesia bill.
The point I’d like to make is not about any particular state, or the federal “No Surprises”, law or the fact that it pains carriers to pay even 2 cents. Instead, it’s about how payors lobbied for and are reacting to the new scheme. It indicates that they know how to play a very long-term game.
Although there are slight differences between the many such laws, the general concept is that carriers must pay the impacted out-of-network providers at mandated levels often based on notions of average contracted rates.
In lobbying for them, the payors clearly understood that these laws would result in putting physicians in a vice grip: Average rates could be gamed.
Many are now refusing to renew contracts that are currently at levels that would skew the average upward. They’re offering very low rates to some groups while keeping rates high where they must — the lower rates will bring the average down. It appears as if their long-term plan is to push the “average” down to where nobody in the popular press (or at some physician specialty associations) thought they’d ever go: close to Medicare.
Payors played the long game. Politicians played the short game (great soundbites, more votes, and retirement before shortages of care hit the fan). Many medical groups and professional societies didn’t play the game at all or, if they did, they focused only on the short-term game, e.g., today’s rates (“carriers must now pay us mandated rates!”), not the longer-term game (“the mandated rate is now only 2 cents!”).
But payor rates are just an example. The notions of long-term and second order thinking apply to how you deal with a hospital in connection with their long-term plan for the service you provide, which doesn’t have to be a traditional hospital-based service. The notions apply to how you are staffing. They apply to deciding what facilities to target. And so on.
In doing strategic thinking for your group, it’s essential that you not only think about this year, next year and a few years down the line, but also farther out. Think ten years, fifteen years out. Sure, you might not be able to control most of what is going to happen over that long-term period, but at least factor it into the way that you determine your strategy.
Some things that are going to have an effect in the future (the long-term) can be seeded, structured and manipulated now (the short-term), if you’ll only engage in that level of thinking.
