Several physician leaders told Becker’s that if they could change one thing to improve their professional lives, it would be the current payer landscape.
James McLoughlin, MD, a spine surgeon at Ivy Spine & Orthopedic Specialists in Panama City, Fla., said he envisions a radical realignment of insurers’ priorities.
“I would like to see an open agreement signed by all payers, stating unequivocally that their primary role and responsibility is to finance healthcare in the U.S. — not to provide reimbursement to their investors,” he said.
Such a shift, he said, would promote “a philosophy of medicine above business, rather than the other way around.”
Dr. McLoughlin also advocated for equitable accountability between insurers and providers.
“I would recognize that statements made to insurers which are deemed inaccurate can be prosecuted as financial fraud; since insurers can claim this of providers, providers and patients should be able to claim the same fraud if inaccurate statements are made to the patients or to the providers by the insurer,” he said. “A level playing field. With damages available.”
Dr. McLoughlin added that insurers unwilling to adopt this approach should be removed from the system.
“If all insurers refuse, simply replace them with Medicare for All,” he said. “That should be their only chance for existence, as they have siphoned off too much revenue for too long — all the while leaving American patients and providers without solutions, and doing it all electronically from their yachts. It is time to fix this mess.”
For many physicians, the burden of prior authorization adds to the frustration of dealing with insurance companies.
“One of the most frustrating aspects of practicing medicine today is how much control insurance companies have over the care we can provide,” said Baha El Khatib, MD, a vitreoretinal surgeon at Vitreo-Retinal Consultants in Cleveland, Ohio. “We spend an enormous amount of time navigating prior authorizations and step therapy requirements just to prescribe medications or recommend surgeries we know are best for our patients.”
When clinical decisions are “dictated by insurance algorithms instead of medical expertise,” it delays care and undermines quality, Dr. Khatib said. The change he hopes for: “a system that empowers physicians to make evidence-based decisions without unnecessary interference — where the patient’s health comes first.”
Gregory Chow, MD, a physician at Aiea-based Hawaii Pacific Health, echoed the sentiment.
“Less influence from insurance companies with regard to prior authorization would greatly improve my work life,” he said.
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