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MedChi Survey of Maryland Doctors Reveals Health Insurer Practices Jeopardizing Patient Access to Effective Care

"Maryland physicians have increasingly voiced their concerns about the significant and potentially dangerous ways that health insurers are intruding in the doctor-patient relationship," said Gene Ransom, MedChi CEO. "Insurance practices such as requiring pre-approval for medical procedures and prescription medications, step therapy, and therapeutic substitution are intended to be cost control measures, but in reality they deny patients access to care and are tantamount to practicing medicine without a license."

Specific findings of the MedChi survey include:

    --  95% of Maryland physicians surveyed said that health insurer protocols
        that impact how and what treatments physicians can prescribe their
        patients had a "somewhat" or "very negative" effect on the doctor's
        ability to effectively treat patients;
    --  88.5% of physicians identified insurance barriers such as pre-approvals,
        step therapy, drug switching, and other protocols as "burdensome," "very
        burdensome," or as a "major hassle";
    --  94% of survey respondents said that health insurance companies in
        Maryland delay or deny prescription medications or diagnostic testing
        for patients;
    --  26% of physicians surveyed report that they and their staffs spend
        between 21 and 60 hours per month interacting with insurance companies
        just to obtain pre-approval on prescription medications and medical
        procedures and to determine requirements for other insurer protocols
        such as step therapy; while another 19% report spending more than 150
        hours per month;
    --  More than 70% of responding doctors indicate that the hidden costs
        associated with meeting health insurer protocols have a "significant to
        crippling" impact on their practice;
    --  Nearly 77% of respondents said that they had considered moving their
        practice to another state, retiring early, leaving the profession, or
        reestablishing their practice as fee-for-service only in order to avoid
        the administrative requirements associated with health insurance
        requirements.

The pre-approval process - when an insurer requires a doctor to obtain authorization from the insurance carrier before the carrier will agree to cover the cost of a procedure or medications - proved to be a particularly onerous burden for Maryland physicians. One busy surgical practice reported hiring two additional employees solely to deal with the administrative requirements of insurance companies, at a cost of $75,000 annually.

"Health insurer protocols not only delay treatment for individual patients, but they also cut into the time that a doctor has to spend with his or her patients - every hour that a doctor spends on administrative tasks is an hour not spent on patient care," explained MedChi President Murray Kalish, MD.

In response to the survey, MedChi today also announced that it will take the following actions to help address intrusive health insurance protocols:

    --  Petitioning the Insurance Commissioner to conduct a comprehensive review
        of pre-approval, step therapy, therapeutic switching and other "cost
        containment" practices currently interfering with Maryland patients and
        their access to affordable, timely health care;
    --  Urging the Health Care Reform Coordinating Council to identify ways to
        eliminate or streamline insurance "cost-containment" practices as
        federal health law is implemented in Maryland;
    --  Investigating the development of a universal electronic process for
        streamlining and expediting heath insurance carrier requirements;
    --  Developing patient protection standards that will more clearly define
        the boundaries around patients and their providers, re-instating
        providers as the primary decision-makers for their patients' health
        needs.

In conjunction with the release of the survey results, MedChi CEO Gene Ransom sent a letter Maryland Insurance Commissioner Elizabeth Sammis requesting a formal review of the most egregious health insurer practices.

"As Maryland moves toward implementing the federal health bill, we ask that you please review pre-approval requirements, step therapy protocols and therapeutic switching policies to ensure ALL Maryland patients have timely access to the care they deserve - as directed by their doctors, not their insurance plans," Ransom said in the letter.

For the complete results of the survey, please visit: http://www.medchi.org/news-and-bulletins/surveys

About MedChi

MedChi, The Maryland State Medical Society, is a non-profit membership association of Maryland physicians. It speaks on behalf of over 22,000 licensed physicians in the state. Its mission is to serve as Maryland's foremost advocate and resource for physicians, their patients, and the public's health.

SOURCE MedChi, The Maryland State Medical Society