NPR’s Michel Martin speaks with American Medical Association President Bruce Scott about how physicians and patients are burdened by insurance companies’ systems of prior authorization.
MICHEL MARTIN, HOST:
A lot has been said about the outpouring of social media posts in the wake of the killing of insurance company CEO Brian Thompson earlier this month, with many of the posts describing horror stories about what the writers said were their fights with insurance companies to get coverage for their medical treatment. But we’ve not heard much from doctors who deal with insurance companies on a daily basis. A major bone of contention is prior authorization requiring doctors to get approval from health insurers before beginning treatment or to assure that the treatment will be covered. The American Medical Association conducts an annual survey of 1,000 practicing physicians to assess how prior authorization affects physicians and the care they’re able to give their patients. Dr. Bruce Scott is president of the AMA and he’s with us now to tell us more about what the survey results say. Good morning, Dr. Scott.
BRUCE SCOTT: Well, good morning. It’s a pleasure to speak with you about this important topic.
MARTIN: Well, thank you for talking about that. So, obviously, the AMA has been surveying physicians on this topic for some time. That’s not because of this recent terrible incident. So how much of a physician’s time would you estimate is spent on administrative tasks related to insurance?
SCOTT: Well, administrative tasks related to insurance, believe it or not, take up about two hours of physician’s time for every one hour that we’re able to take care of patients. And prior authorization specifically, the survey recently found, consumes about 12 hours of physician and staff time each week. And the result is, in a lot of cases, patients actually abandon the treatment. Or their condition worsens during the time that we’re waiting for the insurance company to provide authorization for what the patient and their doctor has decided is the best for them.
MARTIN: You’re a practicing physician. You’ve been practicing for quite some time. So have you seen this over the course of time that you’ve been practicing?
SCOTT: Every week. I had a patient with a tumor growing in her sinus in her cheek below her eye. And we talked about the fact that she needed a relatively large surgery to protect her eye and hopefully save her vision. And believe it or not, a few days later, she gets a letter and I get a letter from the insurance company telling me that the procedure has been denied because she’d not been on an antibiotic and a steroid nasal spray. Now, that might’ve made sense if her problem was a sinus infection, but she had a tumor. So I had to get on the phone, and I talked to the medical director, and we got the insurance approved. But imagine the stress on her.
MARTIN: I’m imagining that insurance companies justify this practice by saying that they’re trying to keep costs contained. How do you respond to that?
SCOTT: Well, the actual results are that it causes increased costs because worsening health conditions because of the delay that result in patients sometimes then seek urgent care. And the results of our survey actually found that the wasted resources – 4 out of 5 physicians reported that it led to higher overall utilization of health care resources.
MARTIN: You cannot but notice that there’s just a lot of anger out there toward the health care system and, I mean, specifically toward insurers. But are you worried that some of this anger might spill over toward you?
SCOTT: Well, let me say that we know that patients are upset. And I hope that patients know that physicians are their advocate. Physicians are working hard to try to help them get the care that they need. And please don’t blame your doctors. Work with your doctors. Many times, the most effective thing is actually a phone call from the patient. The patient can contact their insurance companies. It is the patient who is, in effect, the prescriber, the consumer, if you will, of the insurance product. If you’re in a company, talk to your HR people who can have a connection with the insurance company and make the insurance company aware that you’re upset and that you want to get the care that your doctor has authorized. Those are the constructive ways to approach this, not violence.
MARTIN: That’s Dr. Bruce Scott. He is president of the American Medical Association, the AMA. Dr. Scott, thank you so much for talking with us.
SCOTT: Thank you so much for having us.
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