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Mississippi Business Journal: Transparency is the best medicine; Health Insurer Code of Conduct may improve the quality of care
By Dr. J. Gholson
Many of us entered med school for the age-old reasons generations before have gone into the profession — out of an interest in helping people and curing what ails them.
As a young physician in my first months of practice, I remember prescribing the “gold standard” to one of my patients to treat his ailments, only to berated 20 minutes later because the treatment was so expensive. I explained to him he was getting the best treatment available. He explained to me he would be just as happy with the “silver standard.” Cost has been part of my medical decision
making ever since.
It is getting harder and harder to provide quality care as newer barriers to access arise. Health insurers have different policies related to generics, prior authorizations and formulary changes. The time it takes to keep up with the changes can be overwhelming to a small practice. The lack of transparency regarding those policies by insurers often adds to the confusion and frustration.
Health providers must meet this modern challenge of providing care while still casting an eye to managing costs. Our highest priority is to deliver the best quality care to our patients. How many times have physicians chosen their second or third plan of care simply because it was covered by insurance?
Patients deserve the best treatment possible. Physicians need to know the evidence behind health insurers’ decisions so we can provide knowledgeable high-quality care. Transparency among health insurers will lead to overall better quality and delivery of healthcare.
Overall, the costs to our healthcare system are lower when people can afford their medicines, when they are compliant with the course of care laid out by their doctor and when access to remedies for their unique and particular needs are available. Health insurers should be our partners in this process.
Currently, an effort is under way by the American Medical Association (AMA), and will be considered in upcoming weeks, regarding a Health Insurer’s Code of Conduct. This is a coordinated effort among
state medical groups, specialty societies and comes from a decidedly
physician perspective.
The goal? To challenge restrictive policies without legislative or judicial intervention. To provide data which could lead to reform. To provide patient and businesses with a way to compare the performance of health plans.
The Code would work hand-in-hand with the AMA’s recently released National Health Insurer Report Card (NHIRC), which evaluates claims processing. A Code of Conduct should consider the following areas:
Clinical Autonomy — Allow physicians to make decisions without artificial barriers such as prior-authorization. Formularies based on appropriate clinical evidence. Protecting patients from sudden changes in formularies.
Transparency — Disclosure regarding ranking systems. Disclosure of incentives to health plans, contractors and providers. Disclosures regarding reimbursement and factors affecting changes in prescriptions.
Corporate Integrity — Business practices that do not negatively impact
patient/physician stakeholders, avoidance of conflicts of interest, fair and timely reimbursement.
Patient Safety and Welfare — Real simple. Patients before profits.
There are a number of issues which must be addressed, which include, but are not limited to: Involvement of insurers in the implementation of this policy, consumer involvement and monitoring compliance.
The outcry is building and it is only a matter of time before reform is a reality. Better to meet the challenge head on in crafting good policy which integrates concerns for all parties.
Physicians have a code of conduct of sorts. It’s called the Hippocratic Oath. Many physicians recite it when they graduate from medical school. Part of it goes something like this, “I will prescribe regimens for the good of my patients according to my ability and my judgment and
never do harm to anyone.” I couldn’t have said it better myself.
Jennifer D. Gholson, M.D. is chief medical officer for Information & Quality Healthcare, Mississippi’s Medicare Quality Improvement Organization and president of Gholson Healthcare Consulting, LLC.
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All News Items
August 26, 2010 - The Lund Report: The Best Care Possible: You're Worth It
June 14, 2010 - American Medical News: 10 things health insurers must do to regain trust; The AMA, with endorsement from 68 state and medical specialty societies, outlines steps health plans must take to be credible in the eyes of physicians and patients.
February 27, 2010 - Providence Journal: The creepy third person in doctor’s exam room
November 28, 2009 - Newport News Daily Press: MDs under attack
November 04, 2009 - The Hill: A code of conduct for health insurers
October 27, 2009 - WCBU-FM 89.9 (Peoria, Ill.) radio news
October 26, 2009 - WEEK (NBC - Peoria, Ill.): Developing a doctor-patient relationship
October 12, 2009 - Las Vegas Business Press: Here's a prescription: A health insurers code of ethics
September 09, 2009 - Maryland State Medical Society Resolution 14-09
August 29, 2009 - The Island Packet: AMA code puts doctors, patients in charge of care
August 28, 2009 - Baltimore Times: Group calls on health insurers
August 27, 2009 - Baltimore Times: Nursing Maryland back to health
August 20, 2009 - Lincoln Journal-Star: Pharmacists forced to serve insurers rather than patients
August 19, 2009 - WSTM-NBC3: Prescription medication battle heats up in Central New York
August 17, 2009 - New York State Senator Jeffrey D. Klein blog: For Health or Profit? Klein Unveils Sickly Scorecard of Major HMOs
August 17, 2009 - New York Daily News: Prescription Prescription drug coverage marred by bureaucracy, survey says
August 13, 2009 - Leading African American Groups Call On Health Insurers to Dismiss Restrictive Practices
August 13, 2009 - San Diego Union-Tribune: Bureaucracy won't contain costs
August 01, 2009 - Huntington, W.V. Herald-Dispatch: Insurers put stress on the physician-patient relationship
July 21, 2009 - Chicago Tribune: They authorized back surgery but denied his $148,000 claim
July 17, 2009 - American Osteopathic Association calls for Development of Code of Conduct
July 12, 2009 - Houston Chronicle: Another kind of remedy for the sick; Code of conduct would protect patients
July 07, 2009 - Washington Post: Health Reform: Who Holds the Reins on Care?
July 06, 2009 - NATIONAL HEALTH INSURER CODE OF CONDUCT HITS 1000 SIGNATURES OF SUPPORT
June 30, 2009 - Atlanta Journal-Constitution: Code of conduct needed for health insurers, too
June 24, 2009 - Penn. Pharmacists Association: “A Patient Walks Up to the Counter …”
June 24, 2009 - Pittsburgh Post-Gazette: Broken bonds; The physician-patient relationship is being destroyed by the cost-driven decisions of health insurers
June 09, 2009 - Bellingham (Wash.) Herald: Time for a health insurance code of conduct
June 08, 2009 - Mississippi Business Journal: Transparency is the best medicine; Health Insurer Code of Conduct may improve the quality of care
June 03, 2009 - Frederick (Md.) News Post Op-Ed: Pharmacists pawns in health care's game of chess
June 01, 2009 - KUSI-TV interview with Dr. Jack Schim
May 25, 2009 - San Francisco Chronicle: Doctor pushes back against insurer scrutiny
May 08, 2009 - Fox News Health Blog: Bad Medicine: Is Your Insurance Company Hazardous to Your Health?
April 27, 2009 - Petition for Health Insurer Code of Conduct Garners Widespread National Support
April 20, 2009 - On-line petition launched in support of a national health insurer code of conduct
April 13, 2009 - Petition launched in support of a national health insurer code of conduct
April 09, 2009 - Westchester (N.Y.) Herald letters: Access to Quality Healthcare
April 01, 2009 - Los Angeles Society of Allergy, Asthma & Clinical Immunology Applauds the AMA for Developing Health Insurer Code of Conduct
March 24, 2009 - Arizona Republic: Patient care, not financial gain, must take priority
March 22, 2009 - Rochester (N.Y.) Democrat and Chronicle: Health insurers should agree to a code of conduct
March 20, 2009 - Buffalo News: Code of conduct would protect patients from insurers
March 10, 2009 - AfPA Launches Petition in Support of a National Health Insurer Code of Conduct
March 09, 2009 - Texas Medical Society: Health Insurance Code of Conduct Act of 2009; The Time Has Come
March 09, 2009 - American Medical News: MSSNY president: Insurer settlements highlight need for code of conduct
February 01, 2009 - Colorado Medicine: Health Insurer Code of Conduct?
January 24, 2009 - Fresno Bee: Doctors push code of conduct for insurers
December 10, 2008 - Lupus Agencies of New York State Applaud AMA's Resolution to Develop a "Code of Conduct" for Health Insurers
December 09, 2008 - New York State Rheumatology Society Position Paper: AMA Resolution 823
November 20, 2008 - National Minority Quality Forum Applauds AMA's Health Insurer Code of Conduct
November 14, 2008 - Alliance for Patient Access Applauds AMA's Health Insurer Code of Conduct
November 13, 2008 - Alliance for Better Medicine Calls on California Health Insurers to Adopt a "Code of Conduct"
November 13, 2008 - Los Angeles County Medical Association Reinforces AMA's Call for a Health Insurer Code of Conduct
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