Scary survey results: 64% of MDs base decisions on payer rules instead of what patients need

From Athena Health's Physician Sentiment Survey

Let me state right from the start that I understand why these docs responded this way.  Every day we are hounded by insurance rules and policies that attempt to shape what we do.  In theory this seems like a good idea and many of the policies are easily defensible on paper.  The problem is that in aggregate this approach to managing health care costs has created an impossible situation. 

We are spending hours and hours responding to insurance clerks and less and less time focusing on what our patients need - we just don't have the hours in the day necessary to do all of our work well.

The overwhelming bulk of this work falls to primary care - the most under-resourced part of health care.  Think about the global stupidity of this approach:

• If primary care works well it results in overall better health outcomes and reduces the cost of health care.
• Primary care works less well when it receives only about half the resources it needs to do the work.
• Primary care works less well when in addition to the inadequate funding it is the dumping ground for the overwhelming majority of prior authorizations, formulary adjustments, discussions with Pharmacy Benefit Companies, discussions with disease management companies, and all the other interventions brought to bear by payers in a desperate attempt to control costs.

These policies emasculates primary care leading to:

• The primary care shortage because it is an unattractive career choice
• Increase primary care office overhead as we hire more and more staff to play the game of 'mother-may-I' with insurance clerks
• Increased hamster-wheel care as we pay for the overhead
• More practices going under or selling out to become part of the institutional care machines

The sum total of these things gives us exactly the situation we have today:

• The woefully inadequate population health outcomes we see in the US
• The extremely high per capital health costs we suffer in the US
• The near universal experience of patient experiencing waits and delays, impersonal and rushed care in ever more institutional settings

Is it any wonder that we're seeing a rising tide of PCPs choosing to work for their patients and no longer follow insurance company rules that force them into professional, personal and ethical penury?

Here's one doc of many describing his motivation to stop working for the insurance industry and start working for his patients.

Comments

[Tomfarrellt7]

Sermo poll, take w/large grain of salt...RT @medwriterdg,RT @LGordonMooreMD, 64% of MDs base decisions on payer rules...http://bit.ly/ass3V5