Providence Journal: The creepy third person in doctor’s exam room
By DAVID CHARLES
NASHVILLE
I am a physician — not a politician. But I would have welcomed the chance to join congressional leaders at the Healthcare Summit convened by President Obama this week to reconsider the future of health-care reform.
Health-care reform should be focused on issues that matter most to the average Americans, and few issues are more important than preserving the physician-patient relationship. Americans want the freedom to choose their own doctors. They also want the ability to make decisions about their own health care in consultation with their doctors, without interference from anybody else.
President Obama and Congress would make an important first step towards comprehensive health-care reform if they committed to this year adopting legislation I have dubbed the Physician-Patient Relationship Preservation Act. The physician-patient relationship is increasingly under siege from the government and the insurance industry. When you visit your doctor, too often there is an invisible third person in the room interfering with what you and your doctor decide. This third person, of course, is the patient’s insurance carrier. All too often that third person’s job is to look out for the “bottom line” by trying to force doctors and patients to accept cheaper care.
The tug-of-war between insurance companies and doctors is nothing new, and patients have been caught in the middle for decades. In recent years, though, insurance companies have stepped up their interference and driven a wedge between doctors and patients.
Traditional insurance companies are increasingly resistant to paying the full cost of tests or drugs, a practice that directly obstructs patient care. Legislation is needed to curb this kind of interference, not just to protect patient access to quality care, but to realize needed health-care savings.
A study last year in the journal Health Affairs found physician practices across the country reported spending $31 billion a year on the administrative costs of dealing with health-care coverage plans. Much of the time and money is spent appealing coverage denials that could seriously delay needed care for patients.
This problem is reflected in some common practices of health-insurance providers today.
One very common practice is therapeutic substitution of a prescription drug. This is when a patient goes to the pharmacy to get the drug his or her doctor has prescribed only to be told that the insurance company and the pharmacy want to replace it with another cheaper drug. This is not an identical generic substitute but a totally different drug from what the physician has prescribed.
Destructive delay tactics have also become common. If a patient’s chronic headaches, for instance, increase in intensity, the responsible course of action for a physician is to order an MRI to see if there’s a serious cause like a tumor.
In a disturbing number of cases today, insurance carriers won’t flat out refuse to pay for an MRI or other diagnostic test, but they will make the pre-approval process so burdensome and time-consuming that the patient gives up.
There is a similar delay tactic in drug coverage known as “step therapy.” Before agreeing to cover a prescribed drug, the insurer insists that the patient try one or more cheaper drugs first. Only after these drugs fail will the insurer approve the drug prescribed by the patient’s own doctor. This means that patients must continue to suffer symptoms and possible drug side effects while ‘trying’ medications that the doctor never wanted to prescribe in the first place.
Unfortunately there are other examples, but none are as insensitive to patient welfare or common-sense economics as the insurance companies’ cavalier treatment of patients taking drugs for chronic conditions. In an effort to cut costs, an insurance company will suddenly stop coverage for a drug which is currently being used to successfully manage a patient’s condition. This is an invitation to side effects that could require an expensive hospital stay, all triggered by the carrier’s desire to save a few dollars by making the patient use a cheaper drug.
This all goes back to the uninvited presence of that third person in the exam room. Successful federal or state health-care reform must first preserve the physician-patient relationship. Neither government nor insurance companies should stand as a barrier between patients and their doctors.
David Charles, M.D., is vice chairman of the department of Neurology at Vanderbilt University School of Medicine, in Nashville, and chairman of the nationwide Alliance for Patient Access.
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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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