Time to Unite


Great article in the New York Times, that brings light to the ‘behind the doors,’ deals made by insurance and pharmaceutical companies. Doctors and their patients need to unite to lobby lawmakers in order to stop these practices that are causing financial hardships to both parties.

To add insult to injury, insurance premiums are also going up.  From the patient perspective, does one pay the mortgage, pay for doctor visit co-pays, buy proper groceries, or pay for medications?

From the physician and their staff perspective, does one provide top notch service or spend time sorting out prescription plans?

Despite patient premiums increasing, insurers are also requiring record number of prior authorizations which hinder delivery of prompt care. The need for prior authorizations for all cardiovascular testing and many medications are now taxing cardiology practices.

It is as if the insurers are testing the resilience and perseverance of physician practices to obtain prior authorizations. Can they push through and afford the staff labor to get approval for much needed cardiovascular testing? If we do not try, patients may be harmed. One cant help but wonder if insurers hope the physician staff gives on pursuing authorization for testing in an effort to save money. If a patient has a bad outcome attorneys  purse legal action against physicians and not insurers who stood in the way of appropriate care.

Marked rises in labor hours/costs to fight insurance companies hinderances and documenting immense amount metrics that are required to be compliant with Medicare are slowing killing private, solo, physician practices. As a Cardiology practice participating in an Accountable Care Organization (healthcare organization that ties payments to quality metrics and the cost of care) we are required to document whether we screened a patient for depression. This takes physicians and staff away from direct patient care. Also, many physicians are forced to join large hospital groups or start concierge practices that only a few patients can afford.

This increasing need to investigate medication denials and looking into alternatives is causing an immense amount of labor hours to physician practices. Between staff calling the pharmacy, the insurance company and subsequently discussing with the physician and finally the patient takes hours worth of unpaid work. Again this redirects physician and staff labor to paperwork and jumping hurdles to prompt and appropriate care.

Recently, we had a cardiac patient who had muscle aches on atorvastatin. As directed the patient took the drug a second time at our direction. She previously had a reaction to pravastatin which has been documented.  Hence after the second attempt we changed to rosuvastatin, which recently has become generic. After my staff spend

30 continuous minutes with insurance companies on two different days (for a total  of 60 minutes), the medication is still yet to be approved. The patient currently has no statin medication for heart protection. Another attempt by my staff will be made for prior authorization.

Interestingly, we are also finding that older, generic medications prices are often surpassing the price of their more modern counterparts. If a patient cannot tolerate a new drug or their is a contraindication we reach to older drugs. When this change is made we are spending a lot time trying to get prior authorization for a generic drug. Again making multiple phone calls to the insurance company, the pharmacy, the physician, and then calling the patient with the outcome again takes in immense amount of resources.

There is no immediate solution to this problem.  To start, patients and physicians need to start lobbying our local lawmakers to bring these issues to light by contacting your elected official and/or being vocal. The doctor patient relationship needs to transcend medical care and also focus on policymaking.

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