Physicians want collaboration, not complication, from payers

The physician community has a simple message for payers: Let doctors be doctors.

Doctors’ sentiment is overwhelmingly negative toward payers, identifying more obstacles than true collaboration in primary care. In this issue, we unveil the results of the Medical Economics Payer Scorecard, an exclusive project gathering input from nearly 1,100 physicians nationwide on their relationship with health insurers. 

Physicians are fed up with frequent and lengthy prior authorization calls, with begging for a reasonable fee schedule–or simply taking what they can get–and difficulty in getting paid for their work. They want payers out of clinical decisions and more open to working with physicians rather than creating a combative relationship.

In a value-based environment, improving this relationship is key for both sides. Payers need up-to-date, quality data about their members to make business decisions.

Physicians need metrics that make sense, and to be rewarded for their hard work, not bogged down by red tape and onerous data reporting to prove they are making a difference in patients’ lives.

So how do two sides, forced to work together for decades, repair this tenuous relationship? The answer is to let doctors be doctors.

Physicians who responded to our survey have simple requests. They would like to get back into the exam room, not wait on hold to argue for their latest treatment plan. They want simple online forms and less physical paperwork for themselves and their staff so they can return their focus to patient time. They want clear language – and even some guidance – on denied claims (if told what they are doing wrong, doctors are happy to correct the error; it’s the mystery that frustrates them.) 

If the goal is healthier plan members who utilize fewer services, then that means providing more time for physician-patient interactions. No patient ever got better after a 45-minute phone call with their insurance company about coverage and their bill. In fact, I’d argue their blood pressure alone suffers.

Restore the relationships that matter in healthcare and repair the ones needed to achieve the end goal.

Private practice physicians understand the line between medicine and business; they deal with it every single day. They also know when one side of that relationship overwhelms the other. The general feeling–through our survey and various discussions with physicians–is that a payer’s bottom line is becoming more important than the patient’s journey to wellness.

But physicians will also have to make some compromises for the relationship to work.  Perhaps the role as “payer educator” remains, as patients turn to those they know and trust to help them when they have  questions, even about their coverage and their costs. Maybe it is taking a more active role in properly coding claims and working with staff to streamline the process to get paid faster and more accurately.

A patient’s road to better health has many twists and turns. It’s time for physicians and payers to work together as steady navigators instead of bickering over the best way to get there. 

Keith L. Martin is editorial director of Medical Economics. What would you be willing to sacrifice for a better relationship with your payers? Tell us at medec@ubm.com.