Payers may unintentionally be driving independent gastroenterologists to hospitals

Though payers have been trying to push more procedures out of hospitals, low reimbursements have the potential to cause these efforts to backfire by pushing independent physicians, including gastroenterologists, to migrate to hospital settings.

Robert Pecha, MD, president of Gastroenterology Medical Clinic in Folsom, Calif., recently connected with Becker's to discuss his difficulties communicating with payers as a small, independent gastroenterology practice.  

Note: This response has been lightly edited for length and clarity.

Dr. Robert Pecha:  I am president of a seven-gastroenterologist group. We are one of the last two remaining private GI groups left in the Sacramento, Calif., area. We run an endoscopy center, caring for 7,500 patients per year. 

Our biggest challenge for both the endoscopy center as well as our practice (separate companies) is our inability to communicate with insurance companies to negotiate rates. We are too small for them (e.g., Blue Cross) to talk to us. What they don't seem to realize is that small raises to independent practitioners prevents those physicians from defecting to large hospital-based practices that charge all insurers much more.

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