A healthy dose of skepticism from the owner of a management business for diagnostic imaging centers.

I viewed with interest the press conference in which Vice President Biden announced that hospitals have agreed to forgo payments saving the country $155 billion over the next 10 years. This is followed by drug companies and insurance companies’ announcements to help the federal government in their endeavor to provide a new health care system. However, I know when big businesses and the government start cutting back-room deals, someone is going to get hurt.

That hurt is going to come from small businesses. When you look at health care, most doctors’ offices, independent medical facilities, and other local companies that provide medical supplies and services are small businesses. As a manager of a diagnostic imaging center in Nebraska, I know first hand the challenge of competing with insurance companies, hospitals, and the government.

Our company provides management for outpatient radiology and outpatient cancer centers. Most of our sites are locally owned facilities. We always endeavor to use local small businesses to provide our medical supplies, billing, and employees. Unfortunately, we are able to view with a unique perspective how the big insurance companies and hospitals play.

Over the past few years, the insurance companies and some hospitals in Omaha have cut backroom deals to keep “independents” from participating in insurance plans. In a reverse of “policy,” two large carriers refused to grant their patients the opportunity to visit our facility. One day we were serving their patients, and the next we were told they no longer had a need for more facilities. Subsequently, several of the large hospital networks built four additional new facilities. In essence, the insurance companies removed the competition for the hospital systems.

In an effort to return to “in Network” status, we met with the two large insurance carriers to ask for readmittance on their plans. We were granted an opportunity for our physicians to showcase the patient care our center provides. We showed the carriers’ boards how every patient gets to spend time with their radiologist during a visit. They applauded our cost savings and patient care. They even asked us to provide our data so they could encourage their “hospital partners.” Yet, despite their thrill, they told us it was not in the hospitals’ or their interest to add us to their plans. We have continued to serve all patients despite the payment problems. Yes, often for free.

Why prevent access? Competition is difficult for hospitals. They do not want to compete by providing better, more efficient, or faster service to their patients. The only way to compete is to keep those patients from choosing where they can be treated. Working with insurance companies, they eliminate competition. And their strategy works.

Over the last 5 years, Omaha hospitals have been flush with money. Four new hospitals are under construction. This adds to the 11 other hospitals in the metropolitan area with a population of approximately 800,000 people. This growth comes at a time when most metropolitan areas are consolidating resources.

When hospitals are conducting huge infrastructure expansions, it often means their nonprofit organization is flush with cash. So by working with insurance companies, the large hospital system built new hospitals on the backs of their patients. How do I know? As a small business owner, I also provide health care to my employees. During the same time, the insurers funneled patients to the hospitals, our employees’ premiums went up 36% in 3 years. The same insurance companies that refused our facility to participate in their plans raised our employees’ premiums drastically.

I am under no illusion that our health care system is perfect. Rapid growth in radiology procedures prompted the government to slash payments—in some cases by 40% in 2007. In order to stay in business, outpatient radiology facilities had to become efficient or risk bankruptcy. In fact, many outpatient facilities perished under the cost cutting in the 2005 Deficit Reduction Act. Today, the facilities left in the marketplace are well run and efficient, and provide a valuable service to patients. The majority of these facilities are small local businesses. So it is frustrating to see the survivors of the government’s cuts in place since 2007, faced with the gamesmanship of large hospitals and insurers unwilling to allow the free market and competition to provide lower cost care for patients.

Let’s hope I am wrong and small business is spared by the Washington deal making with hospitals and insurers. If the quintessential Middle America City, Omaha, is any indication, it is going to be a tough road for small medical businesses.

Chris Christenberry has more than 25 years of experience in health care in both the United States and Europe. He is CEO and president of Atlantic Health Solutions, which provides operational, financial, and sales leadership for outpatient radiology and oncology facilities.