By ROB LAMBERTS, MD

We are losing patients.  Certain insurance companies are trying to “play hardball” with doctors, unwilling to negotiate with us over their outlandishly low rates.  We have lost patience.

So the signs went up in the exam rooms today:

As of the start of the year, we will only accept X, Y, and Z Medicare advantage plans, and we are presently negotiating with A and B insurance companies.  Please consider this when enrolling in plans.

It is highly likely we will drop one of the insurance plans altogether, and we are one of the last practices in our town to accept them.

Patients are distraught.  Some of them who have seen us for years are now going to have to go elsewhere, while others that just joined our practice because their previous doctors dropped out of the plan will once again have to find a new doctor.  Patients aren’t mad about this, just sad.  The conversations go like this:

“So you are dropping X insurance?”

“We will if they don’t change.  They are paying us significantly less than other plans.”

“That’s crazy.  We just left a doctor because of the same thing.  Now we have to move on.”

“Yeah, I am very sorry about that.  I just want to see patients; I don’t want to do this kind of thing.”

“Well, I don’t blame you.  They pay $1000 for an ER visit for an ear infection, and they won’t pay you what you charge?”

“Apparently not.  They have been playing hardball with primary care docs recently.  That’s why nobody is accepting it any more.”

“I don’t know what we are going to do.  I hate changing doctors again.”

“Call your employer and tell them about this situation with the insurance they’ve chosen.  The only way things will happen is if employers get mad at the insurance companies.”

There is no anger, just disappointment and frustration.  Patients are victims of the strategy insurance companies are using to cut cost.  But why cut primary care?  Why low-ball the one group of doctors who don’t cost that much and who can actually save money?  It makes no sense to me.  It certainly doesn’t make sense to my patients.

Come December, we may be putting a similar sign up:

Due to the 23% cut in our reimbursement by Medicare, we are no longer accepting new patients and may soon be forced to drop Medicare altogether.

It’s happening in a lot of offices already.  The problem is that these patients won’t have an employer to tell.  These patients won’t have a choice.  Medicare won’t come back to the table if there are no PCP’s.  They don’t negotiate their rates.

See those clouds on the horizon?  They look harmless, but they’re not.  It’s a storm that will kill a lot of people if we don’t do something soon.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.