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  • Writer's pictureThe San Juan Daily Star

Physicians, radiologists back bill that would allow care providers to negotiate contracts


Radiology Society President Dr. Alvin Almodóvar

By The Star Staff


The presidents of the Physicians and Surgeons Association of Puerto Rico and the Radiology Society (SOCRAD), Carlos Díaz Vélez and Alvin Almodóvar, respectively, expressed support on Wednesday for House Bill (HB) 1641, which would allow health care providers to organize themselves by specialty to collectively negotiate the rates, terms and conditions in contracts with health insurers.


The legislation would amend the Puerto Rico Health Insurance Code. In addition, it would establish the administrative agencies assuming responsibility for regulating collective bargaining.


Díaz Vélez noted that as it stands now, “insurers have a dominant position in negotiating prices and terms of medical services.”


“Physicians often have little or no bargaining power and are required to agree to the insurers’ terms in so-called insurer-imposed adhesion contracts,” he said.


He added that “doctors cannot offer high-quality services due to pressure to reduce costs, which negatively affects the quality of medical care patients receive.”


Díaz Vélez said allowing doctors to join groups for negotiations “would give doctors more power to deal with insurers to achieve better conditions for the medical class and patients.”


“Another benefit of collective organizing is that it can help improve the efficiency of the healthcare system,” he said. “Physicians working together in an organization can share resources and knowledge, which can help address physician shortages by allowing physicians to work together and share the workload without impacting an individual physician’s finances.”


In a public hearing held last week, the Insurance Companies Association (ACODESE) declared that collective bargaining could cause an increase in uninsured people, threaten the stability of the health system or even create monopolies of doctors.


Díaz Vélez pointed out that ACODESE’s reading of the measure is “unfounded.”


“What this bill (HB 1641) proposes is a negotiation process supervised by the Insurance Commissioner to advance the public interest of improving the quality of medical services to patients …” he said. “This bill represents a necessary means for the Physicians and Surgeons Association to advance other contractual conditions, in addition to the rates, which also affect the provision of medical services and the health of patients.”


Díaz Vélez added that “nothing in the health industry moves without a physician’s license.”


“There are no pharmacies, and there are no profits, neither for the patient nor the pharmacies,” he said. “Without doctors, there are no laboratories, no profits, no admissions to hospitals, no prostheses to put on patients, and no medical plans, neither public nor private. However, we doctors are the most mistreated by insurers, which are privileged here, because it is the patient’s privilege that allows insurers to enter this industry. That is the raison d’être of insurers, a privilege.”


“Insurers are not the ones that should be driving the car in the healthcare industry,” Díaz Vélez argued. “The insurers are part of the system and have the right to obtain their profits, but not to impose criteria on the medical class, which is the one that has fought, worked and struggled to get where it is. The government has to act on the insurers; it is not to eliminate them, but to make it clear to them that they have a specific role in the system and that role is not to own the health system.”


Almodóvar, the SOCRAD president, said meanwhile that the measure could address many of the reasons for the outmigration of doctors from Puerto Rico.


He said the legislation could address “the unilateralism in contracts by insurance entities and health service organizations.”


At the same time, it could help prevent “the denial and delay in awarding provider contracts by insurers and health service organizations despite having all credentials up to date,” he said.


“It would also help address the delay and denial of reimbursements for services submitted for insignificant errors that do not imply error in the billing of services, be it coding, typographical and many others which are unfairly attributed to the provider maliciously,” the radiologist said..


He also noted that HB 1641 would help limit the denial and delay of services and medical prescriptions by the treating physician by requiring “authorizations” beyond a bona fide medical order by a licensed physician.

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