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Don't Make Patients Run Out the Clock

By Dr. Shameka McElhaney ####

Despite the passage of health care reform, the challenge here in Georgia is balancing rising health care costs while trying to improve the health of our citizens.  True comprehensive health care reform will always allow physicians to treat patients in a way that provides consistency and safety.

Every day, my goal is to give personal attention to each of my patients, focus on their needs and work together with them to improve their health. However, my staff and I find that an inordinate amount of time is wasted on administrative duties such as paperwork and phone calls to private health insurance companies seeking approvals for medical tests, needed procedures and access to medications. This reduces the time I have to efficiently take care of patients.

Usually, I am happy to have company, but in this case, I would rather not.  That is why it was discouraging to read that a national survey conducted by the American Medical Association showed that “health insurer requirements to preauthorize care has delayed or interrupted patient care, consumed significant amounts of time, and complicated medical decisions.”

In the survey, 69 percent of physicians, nationwide, typically wait several days to receive preauthorization from an insurer before they can prescribe a medication, while 10 percent wait more than a week.  Keep in mind that during this entire wait, patients may be in serious pain or “running out the clock” on life-saving treatments.

Waiting periods are not the only tactic.  Recently I had a patient return to my office concerned about her worsening condition. She showed me the medicine she received at the pharmacy and accused me of giving her "bad" medicine - that wasn't what she had been prescribed in the past. I pulled her chart and immediately realized her medicine was changed at the pharmacy, as directed by her insurance company. This practice is called "switching" and is more prevalent than most might think.

Insurance companies often use tactics that include forcing patients to switch medicines, even when they are stable and doing well on their current treatment.

Unfortunately, some attempt to take advantage of this problem.  One pharmacy chain, for instance, recently implemented a system to “proactively identify lower cost products” even when there is no generic available.  In short, they are encouraging pharmacists to switch a patient’s medicine, not to a generic form, but to something altogether different than what the physician prescribed.

Health care is not a "one size fits all" type model. Many medicines are fine-tuned to a patient's specific needs and slight alterations or deviations from that treatment can cause adverse effects. I should have the ability to prescribe a medicine to my patient and we should both be able to rest assured that when the patient picks up that prescription from the pharmacist that is exactly what the patient is getting.

As we engage in a more active conversation around health information technology and its impact on improved patient safety and outcomes, we must ensure these advances in technology support the patient – and ensure they receive the medication and care as directed by their physician.  An environment that supports these efforts will help us achieve comprehensive reform, with the patient where they belong – at the center.

Dr. McElhaney is a family practice doctor at WellStar Powder Springs Medical Center.


Comments (1)

Diana Mitchell
Said this on 2-17-2011 At 01:39 pm

I enjoyed reading this article and was glad to know that doctor's realize the interupptions in patient care by insurer's.  Recently, I went to the OBGYN for care and was prescribed progesterone.  When my husband went to the pharmacy to get the medication, the pharmacist stated that the doctor needed to contact the insurer to provide a reason for why this medication was needed.  Well by this time, the office had closed and I was unable to get the medication until the next day.  This interruption was quite disturbing.

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