Doc: Payers shouldn’t play a role in clinical process

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A battle between physicians and payers continues to rage over patient treatment options. But it became personal for one cardiologist when he became the patient. 

Kevin R. Campbell, M.D., a cardiologist and professor of medicine at University of North Carolina, wrote in a column for Fox News that insurance companies’ focus on the bottom line impedes doctors’ abilities to prescribe the best treatment options.

“This dynamic is problematic because in medicine, as trained and educated professionals, we doctors base our therapy decisions on the best available data, and apply what we know to be most effective to each individual clinical setting and patient,” Campbell wrote.

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Being in the patient’s shoes opened his eyes to the disconnect between physicians and payers on treatment options, Campbell wrote. He said that after some trial and error, he and his own physician found the right combination of medication to control his cholesterol. His insurance company then chose to stop covering one of the two drugs, Campbell wrote, and denied his multiple appeals for an exemption--instead telling him, essentially, to just try another, cheaper medication.

Campbell acknowledges that insurance companies are for-profit, so they are naturally concerned with costs, but he said that allowing payers to play a role in the clinical process is dangerous. Doing so, he wrote, may “cloud the picture and create the opportunity for bias,” ultimately to patients’ detriment.

Physicians have also clashed with payers over “step therapy," in which patients are encouraged to get less-expensive medications that are chosen by the insurance company, not the doctor.

In addition to payers meddling in the clinical process, the high-deductible plans that many offer lead many patients, especially low-income patients, to cut corners when it comes to their care, according to an article from CNBC. Patients with these plans are less likely to visit the doctor for even basic, preventive care. They may also be unaware of health savings accounts, according to the article, which can help them save for care.

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