COVER STORY—A tremendous win: Reflection from Boulder County by Leto Quarles, MD, BCMS Immediate Past President

{This piece is the featured cover story for Colorado Medical Society’s March/April issue}

A tremendous win: Reflection from Boulder County

By Leto Quarles, MD, BCMS immediate past president

The Boulder County Medical Society celebrates the court decisions to block the proposed mergers of Aetna-Humana and Anthem-Cigna. This is a tremendous win for medicine and our patients. Thanks in good part to the tireless efforts of the Boulder County Medical Society, Colorado Medical Society, and American Medical Association attorneys, staff and physician leadership, the U.S. Department of Justice has sided with physicians and our patients against these insurance mega-mergers.

BCMS sent a 14-page letter to the DOJ in June 2016 urging them to block the Aetna-Humana merger, concerned about high market concentration in Boulder County should the merger be approved. The devastating impact was demonstrated in data from the AMA and federal Centers for Medicare and Medicaid Services.

It would have given the merged company a near monopoly in our area, allowing the payer to dictate reimbursement rates and terms to physicians, and leaving Boulder County physicians in a financially perilous position, one in which neither choice – staying in-network and accepting lower reimbursements and further imbalanced terms, or walking away and losing a large bulk of our patients – was viable or acceptable. It would have significantly added to physician attrition through retirement, relocation and transition to non-clinical careers; substantial losses that our growing Boulder County population could not afford.

For our patients, clinical decision-making would have been further disrupted. One very powerful insurer could channel the bulk of our patients though whatever convoluted, arbitrary and minimal-recourse processes of prior authorizations and mandated formularies and facilities they chose to impose. The most serious consequence of preferred network referrals, restricted formularies and panels, and poor reimbursement is that, ultimately, they dis-incentivize us to properly care for our sickest, most medically complex, and therefore most expensive patients.

At a time when so much is changing in the business of medicine, I am grateful to have the strength, wisdom and experience of organized medicine at my back.

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