This finding underscores a disturbing reality for the nation: As physicians lose more control of medical decision-making to unqualified insurance company personnel, many doctors are looking to leave the profession, escalating a shortage of primary care physicians projected to reach between 14,800 and 49,300 practitioners by 2030.  As documented in
"These findings put a spotlight on health insurer practices that interfere with shared decision-making and harm patients," said
Charting the experiences of 600 physicians practicing family medicine, internal medicine, pediatrics, and obstetrics/gynecology,
At the same time, the survey identifies the insurance practices doctors worry are compromising the health of their patients. A concern cited by nine in ten of those polled (89 percent) is the use of algorithm-based programs. Additionally, 90 percent denounce a practice known as step therapy, sometimes referred to as "fail first," which forces patients to try and "fail" on one or more less expensive treatments first before the insurer will cover the one the doctor prescribed.
Similarly, 91 percent of doctors point to specific insurance practices – nonmedical switching and prior authorization – as harmful for patients. In the case of nonmedical switching, insurers force patients who are stable on a particular drug to take a different, usually less effective medicine to save money, by making cost-prohibitive changes to the insurance plan. With prior authorization, clinicians must go through a time-consuming process to get approval from the insurer before the plan will pay for the test, treatment, or procedure. According to the survey findings, 87 percent of physicians worry that their patients' conditions could worsen due to the lag time caused by the prior authorization process.
"There is growing evidence that insurance practices like prior authorization, step therapy, and nonmedical switching negatively affect clinical outcomes," said
Besides documenting the harm to patients when health plans override doctors' professional judgement, the new research exposes the toll on physicians when they lose their clinical autonomy to health insurers. The survey found that 90 percent of physicians have diminished time for patient care due to the administrative requirements instituted by health plans, and 77 percent had to hire extra staff to handle the paperwork submitted to insurance companies. This finding builds on research from the
"Primary care physicians are on the frontlines in treating American families, and their perspectives on the declining role of physicians in making treatment decisions for their patients deserves national attention," said
Conducted for the
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