Doctors: Insurance companies endanger patient care

August 26, 2008

Physicians in Ohio and across the country say that insurance companies are increasingly strong-arming doctors to provide the treatment that is best for the bottom line, not for the patient, a newspaper reported.

A nationwide survey of doctors by the Toledo Blade shows they increasingly feel that insurance companies erode the doctor-patient relationship and often prevent patients from getting necessary care by second guessing doctors’ decisions.

The rising costs of health care procedures has led insurers to constrain treatment options available to doctors in an attempt to hold costs down, according to the majority of doctors surveyed. Doctors said the motive is a drive for profits, while the insurers said it’s necessary to hold down the costs for businesses that usually pay the majority of health care premiums.

By failing to police the use of expensive medical resources, doctors admitted they share part of the blame for the tremendous increase in the costs of health care, which costs the U.S. $2.4 trillion per year. But a disproportionate backlash from insurance companies trying to control costs has hurt their patients and their practices, doctors said.

“The decision-making of the physician is being challenged and compromised on a daily basis,” said Dr. Warren Muth, a general surgeon in Dayton and president of the Ohio State Medical Association. “We are trying to take care of people. Get out of our way.”

The Blade’s eight-month investigation involved interviews with roughly 100 doctors and gathered data from an unscientific survey that received more than 900 responses. The online survey was sent to the Ohio State Medical Association and to the American Medical Association, which then sent the survey to its members.

Insurance companies said the survey was unrepresentative because it only included doctors who had joined associations to lobby for them, and would therefore be more likely to have complaints.

Other survey findings include:

About 99 percent reported interference by insurers in their treatment of patients;

95 percent said insurers interfered with decisions about prescriptions;

86 percent said interference compromised patient care;

65 percent said they were unable to successfully protest denials.

Insurance companies, however, claim oversight is needed. As doctors order more tests, procedures, and expensive medications, insurers are increasingly mandating pre-authorization to control rising costs for businesses.

“They don’t really like it when we ask questions about what they’re doing,” said Kelly McGivern, president and chief executive of the Ohio Association of Health Plans.

Businesses demand both quality care and affordable costs, insurers said.

“(Employers) pay the bills and they write the check, so they have the discretion,” said Dr. Robert Rzewnicki, chief medical officer of Medical Mutual of Ohio, the state’s third-largest health insurance provider.

Only about half of all doctors are in the American Medical Association and the Ohio State Medical Association, he said, and those doctors join because they are interested in lobbying for changes.

The nation’s largest insurer, UnitedHealth Group Inc., made $4.7 billion last year. Its president and chief executive, Stephen Hemsley, received $13 million in total compensation.

“Insurers have been trying to practice medicine from an economic standpoint, and what we are finding is that what we think is the best thing for the patient isn’t the best thing for the insurance company monetarily, and therefore it gets nixed right off the bat,” said Dr. Marc Saunders, a surgeon in Warren, Ohio.

Linda Dull, of Ashland, Ohio, has struggled to get the Medicaid insurer for her 11-year-old son, Gunner, to pay for the behavior medications prescribed by his doctor.

“It is just terrible, and I don’t know what to do,” Dull said. “It’s expensive, and we don’t have the money.”

Source: The Blade.

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