An Answer to Wasteful Health Care Spending

The Alliance for Patient Access has an answer to Sen. Lamar Alexander (R-Tenn.)’s request for ideas on reducing health care spending: Hold the physician-patient relationship above wasted expense.  

Senator Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, made headlines in late December when he invited Americans to submit their ideas for reducing health care costs.  March 1 marked the end of accepted proposals, including one from the Alliance for Patient Access.

Submitted by AfPA Chairman and Tennessee neurologist David Charles, MD, the letter outlines how the “overuse, misuse, and abuse of utilization management” is driving up health care costs.  

  • A 2017 analysis of commercial health plan claims by the Institute for Patient Access showed that cost-motivated medication switches led to higher downstream costs for non-drug medical expenses, the letter explains, such as doctor’s appointments, ER visits and lab tests.  
  • Research from the American Medical Association shows that physician practices spend about 15 hours each week just on prior authorization paperwork, and that about one-third of physicians have a staff member whose sole, dedicated responsibility is handling prior authorization requests.
  • A new study from the Alliance for Patient Access shows that patients who experienced non-medical switching, where insurers attempt to boost profits by switching stable patients to a less-costly medicine, experience more physician visits, more appointments with specialists and more travel for appointments and tests.

Meanwhile, it’s impacting quality of life.  AfPA’s national poll revealed that non-medical switching leaves patients feeling anxious, confused and helpless.  And a national poll of physicians showed that frustrations with health plan barriers have led two-thirds to say they would actually recommend against a career in medicine.

A Better Way

What can policymakers do?  Empower physicians to make “informed, personalized decisions about the patients entrusted to their care,” Dr. Charles explained.  AfPA’s letter delineates a health care system where care decisions are monitored, but not held hostage by health plans’ labyrinthine authorization requirements.

“Let’s allow sick people to get the treatment their doctor prescribes directly,” the letter emphasizes, “without unwarranted delay, hassle and expense, rather than have them and the health care system pay the price for mismanaged care.”

The letter outlines a process by which physicians and patients’ decisions would be approved automatically, with insurance companies reviewing practices 90 days after services to identify any physician or medical practice functioning out of line with professional society practice guidelines.  “In this way,” the letter explains, “physicians would be held to the highest, science-based expectations of their fellow professionals – not guided by the financial interests of patients’ health insurance companies.” Health plans could impose warning and probationary periods if intervention proved necessary.

The result?  Fewer wasted staff hours, less wait time for sick patients who need care and fewer dollars spent on emergency room visits, extra appointments and labs, and complications related to nonadherence.  And, most importantly, better health outcomes for Americans.

“Address head-on the trillions of dollars spent wastefully each year in our health care system,” Dr. Charles appealed in the final lines of the letter, “by shaping a system that holds the physician-patient relationship as paramount.”

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