Sometimes the mergers are stopped, however, such as when a federal judge thwarted the merger effort of giants Anthem (a Blue Cross plan operating in 14 states) and Cigna, the country’s number two and number four insurance providers.

Why are so many physicians struggling with insurance billing and collections?
What has happened to the actual practice of medicine? From my experience, practicing medicine has become less important than managing the office. Physicians and their administrators spend so much time trying to stay current and doing billing and collections paperwork, including proper coding of insurance forms, that patient care can suffer. If coding isn’t done correctly, by the latest guidelines or regulations, the office could lose thousands if not hundreds of thousands of dollars in insurance reimbursement, so this function is essential to a fiscally sound practice. This paperwork nightmare must be properly navigated to ensure that physicians’ offices get properly paid.
Why else do physicians decide to sell their practice?
In addition to the massive paperwork nightmare, market and regulatory factors motivate physicians into practice models that call for greater collaboration and interdependence, sometimes making mergers or even employment by a hospital attractive.

There are also financial risks and many complex payer negotiations when a physician considers independence vs. employment. Independent physicians take on more financial burden than their employed counterparts. There are also emerging generational trends: younger doctors seem to be less interested in entrepreneurship and more interested in predictable hours and salary.

As contracts with payors have become more complex during the past several years, many doctors consider the prospect of negotiating payments for a small practice to be nearly impossible. Sometimes larger nearby healthcare systems have preferred provider status. The reimbursement that smaller practices can then negotiate for medical services provides minimal, if any, profit margin with which to run a medical business.

The solution
However, these problems could be handled in other ways than selling the practice. The back office functions of billing, collections and insurance reimbursement could be handled off-site by a separate company, allowing the medical practice to focus on the practice of medicine. This would also enable the doctor(s) to keep their practice, remain independent and not “sell out” to larger conglomerates.

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