Aimed Alliance Survey: Insurer Interference with Physicians’ Professional Judgement Compromises Patient Health; Many Doctors Looking to Leave the Profession

Nine in ten primary care physicians (92 percent) say staff employed by insurance companies are not competent to make medical decisions about treatment regimens, according to a new survey released today by the Alliance for the Adoption of Innovations in Medicine (Aimed Alliance).

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.^[1] As documented in Aimed Alliance’s new survey, 89 percent of today’s primary care doctors say they no longer have adequate influence in making health decisions and almost half (47 percent) worry patients are losing confidence in the care physicians provide. In response, almost half of the physicians who treat American families (48 percent) are considering getting out of medicine and 67 percent would not recommend a career in medicine to aspiring medical professionals.

“These findings put a spotlight on health insurer practices that interfere with shared decision-making and harm patients,” said Nellie Wild, Aimed Alliance Policy Advisor. “Today, decisions about a course of treatment that were once made by the doctor and patient are being questioned, and often overturned, by health insurers to control costs. The consequences are poorer health outcomes for patients and increased costs for the health system, neither of which are acceptable byproducts of cost containment efforts.”

Charting the experiences of 600 physicians practicing family medicine, internal medicine, pediatrics, and obstetrics/gynecology, Aimed Alliance’s research reveals the extent to which insurers now override doctors’ treatment decisions. Specifically, 87 percent of practicing physicians report that health plans interfere with their ability to prescribe individualized treatments, and 79 percent say insurance companies have a negative effect on care. This comes as a time when four in ten of the physicians polled (41 percent) recommend patients order medications online from other countries to get the drug their physician prescribed. Yet, ordering foreign medications online is both illegal and carries significant risks because the drugs are more likely to be counterfeit or substandard to medications that have passed rigorous American regulatory standards.[2]

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 Shannon Ginnan, MD, Director of Medical Affairs for Aimed Alliance. “While the cost of treatment is a legitimate concern, there is little hope of reducing the burden of serious disease and bending the cost curve for the nation’s health system if insurers ignore the professional judgement of highly trained physicians and deny or delay needed care in the name of cost-control. It is time for common-sense solutions that put patients first.”

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 American Medical Association (AMA) showing that to complete the prior authorization requirements insurers impose, a medical practice spends an average of 14.6 hours each week to complete the information – the equivalent of nearly two business days.[3]

“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 Dr. Ginnan. “Medical professionals feel angry and frustrated knowing that unqualified insurance company personnel have the power to override their professional judgement and that the long-term health of their patients is being compromised so health plans can achieve short-term cost savings.”

Conducted for the Aimed Alliance by David Binder Research, the survey consisted of 600 online interviews with primary care physicians currently practicing in the U.S. between February 25 and March 2, 2018. The margin of sampling error is ± 4.0 percent at the 95 percent confidence level. To read the survey report and its accompanying infographics, click here.

About Aimed Alliance

Aimed Alliance is a tax-exempt, not-for-profit organization that works to improve access to quality health care by conducting legal research and analysis; developing sound, patient-centered recommendations; and disseminating its findings to inform policy makers and increase public awareness. To learn more about Aimed Alliance, go to www.aimedalliance.org.