Are 'monopolizing' entities eroding physician independence?

Many physicians are wary of the rapid growth of Optum, the country's largest employer of physicians and parent company of ASC chain SCA Health. 

Udaya Bhaskar Padakandla, MD, president of the Texas Society of Anesthesiologists, joined Becker's to discuss physician workforce trends and payer behavior. 

Editor's note: These responses were edited lightly for clarity and length. 

Question: What physician workforce trend is the most concerning to you right now?

Dr. Udaya Bhaskar Padakandla: The trend that currently concerns me most is the vertical integration sweeping the healthcare industry. Physician practices are being bought out or acquired in a trend that is sweeping across this nation (now 90,000 strong) with Optum. Two things about it bother me more than any other: This increasingly leads to loss of independence in the decision-making ability of physicians in patients' best interest, and second, government watchdogs (like the FTC) are passive onlookers to this dominance of the physician workforce by a monopolizing entity. But at the same time, much smaller physician groups (with 3,000 to 5,000 physicians) get sued by the same entity for "monopolizing" the marketplace.

Q: What payer behavior would you like to see changed in 2024?


1. I would like to see them remove/eliminate all prior authorization of patient care. It has now become crystal clear that PA is a tool they have unleashed to contain costs and maximize their profit margin and have absolutely nothing to do with improving the healthcare of the patients. Patients are the primary victims of the compromise in healthcare and providers are the collateral victims by means of denied payments and delayed payments.

2. I would like to see them play a fair and honest game in disclosing all the factors that are involved in calculating the qualifying payment amount as part of compliance with the No Surprises Act. Transparency at all levels of payer involvement is sorely missing (be that PBM payments, GPO deals, pharmacy benefits or electronic transaction fees).

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