2y ago

Doctors With Histories of Big Malpractice Settlements Now Work for Insurers

www.propublica.org

Doctors working for health insurers can rule on 10,000 or more requests for care a year. At least a dozen were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.

News @lemmy.world

girlfreddy @lemmy.world

2y ago

Doctors With Histories of Big Malpractice Settlements Have Found a New Home in the Insurance Industry

www.propublica.org /article/malpractice-settlements-doctors-working-for-insurance-companies

12 comments

"profit driven death panel"
health insurance profits only exist at the expense of human suffering
- If democrats knew what they were doing communication wise and weren't complicit, they'd use this language of 'corporate death panels'. But of course, if you criticise the insurance industry you criticise Obamacare, and Obamacare is perfect.
  
  obamacare is a conservative love letter to the health insurance companies.
  if it werent for the pre-existing conditions clause we would have gotten nothing.
  obama was a complete failure as a democrat... but a spot on republican.
I don't like insurance companies. But the skills required for surgeon vs medical director are vastly different. Lacking the skill to perform a surgery doesn't preclude the knowledge of medical necessity. I don't have any problem with someone switching careers when one clearly isn't working out, especially when the one not working out is 'surgeon'.
- Except these physicians are often completing something called a "peer-to-peer" on behalf of the insurance companies, not just making broad treatment decisions. This is a process by which an ordering physician is required to call a physician employed by the insurance company to justify a testing or treatment course to their "peer". Unfortunately these "peers" are often composed of physicians who did not complete residency and/or who do not currently practice, let alone in the specialty of the physician who is required to call for the peer-to-peer.
  This leads to rather absurd results in which a board certified, practicing sub specialist (cardiologist, neurosurgeon, oncologist, etc) with 5+ years of specialized training after medical school has to convince a physician who may never have even practiced that they know what they're doing. I personally think if you're not a neurosurgeon, neuroradiologist, or neurologist then you aren't really qualified to cancel a neurosurgeons MRI, but hey, I don't get a bonus for denying claims.
  A Fourth Year Medical Student and Pharmacist
  
  From what I can tell, those peer to peers are primarily used to make the physician decide he doesn't want to waste the time doing a peer to peer. You'll eventually get to the point that the insurance company WILL be liable for adverse outcomes for denying the intervention, and they want to toe as close to that line as possible.
- you clearly didn't consider the implications of "histories of big malpractice"
- It really does though. Medicine is far too siloed and far more specialized now days than most people realize. This makes it nearly impossible for someone to really be able to determine medical necessity outside of their specialty. I would never trust a surgeon on endocrine issues or an emergency physician on primary care. The skill set and knowledge is just so wildly different.
  There is a reason physicians are trying to get laws passed that would require peer to peers be conducted by people in the same specialty.
Pro publica does some amazing reporting.
Every industry needs a place for the bottom of their class.

12 comments