President Reagan once said, “The nine most terrifying words in the English language are, ‘I am from the government, and I am here to help.’ One of the main foundations of conservatism is the idea that an overambitious government can do more harm than good. In that vein, I am concerned that our health care system is moving towards a more obstructive government controlled model of health care. Many health care practices that we Americans see as necessary or important are slowly becoming things of the past or a recent memory. Frighteningly, the most important component of our healthcare system – the patient-physician relationship – will soon join this list. My father, a physician and surgeon, left the Canadian system of socialized medicine because the centralized control of care was too restrictive for the practice of medicine. I believe that the preservation of the doctor-patient relationship is the foundation of personalized and quality care.
Unfortunately, it seems that the proliferation of insurance policies in our current healthcare system often focuses more on the art of paperwork than on time spent with patients. The complexity of our system has added unnecessary layers of bureaucracy which has resulted in wasted time, limited resources and significant delays in care. While it is important to ensure that administrative care resources are properly used, some policies such as prior authorization need to be modernized as they create a wedge between physicians who are physicians and patients who receive care. quality.
Prior authorization is often used as a tool to ensure that physicians prescribe the most appropriate treatment plan; however, last year, in a survey of doctors in Texas, 85% said that prior authorization delays access to care. In another survey, the American Medical Association asked more than 1,000 physicians about prior authorization policies, with 79% say that prior authorization sometimes even leads to discontinuation of treatment. From my personal experience as a physician, it is extremely troubling to me that an administrative burden blocks patients’ access to treatment. What is the value of developing a relationship with your patient if the insurance company or the government is just going to tell you how to treat your patient? Did they go to medical school?
Instead, we should be looking for solutions that provide models of care that encourage quality care rather than overbreadth from insurers. Value-based models are most effective in increasing the quality of care, while controlling costs and inappropriate use. Patients and their providers should be empowered to decide which treatment plan, including prescribed medications, will be most appropriate and effective for them. Not an insurance company employee or government bureaucrat who has never even met the patient. This is why I am an original co-sponsor of the An Act to improve access to timely care for the elderly (HR 3173 / S. 3018). This legislation will standardize and streamline the use of prior authorization in Medicare Advantage plans and improve the transparency of the Centers for Medicare and Medicaid Services regarding the use of these policies.
My home state of Texas is taking steps to reduce delays caused by pre-authorization through the The law on the gold card entered into force last month. This law rewards and encourages physicians who have a proven track record of consistently meeting prior authorization criteria, while maintaining oversight for those who do not meet program requirements. Similar to a gold card rewards program that can be offered at a local restaurant or even through your credit card company, this law will grant “gold card status” to physicians who meet 90% pre-approval rate over six months. Doctors holding a “gold card” will be exempt from seeking prior authorization from public insurers for certain services, allowing them to focus on the patient instead of spending time on paperwork.
Streamlining and reducing unnecessary bureaucracy would benefit not only doctors and patients, but also representatives of other parts of the healthcare system, such as pharmacists, hospitals and insurance companies. In fact, several of these organizations jointly signed a consensus declaration highlighting the improvements that should be made to the system of prior authorization in both public and private markets, including policy suggestions that were ultimately added to the Improving Seniors’ Access to Timely Care Act and the Texas Gold Card Act. These are policies that are widely supported and seen as having the potential to reduce treatment times and unnecessary administrative burdens for physicians while improving the physician-patient relationship.
Having practiced for almost 30 years before coming to Congress, I know the patient and physician should dictate treatment and care plans, not insurance companies and certainly not the federal government. The doctor-patient relationship is the cornerstone of the American healthcare system and it is what sets our high quality care apart from the rest of the world.
Michael burgessMichael Clifton BurgessBurgess: Artificial Intelligence is Key to Future Diabetes Care The Hill’s 12:30 Report – Presented by Facebook – Ninth House Dem Announces Retirement The Hill’s Morning Report – Presented by ExxonMobil – Biden Welcomes Infrastructure Act and talks to Chinese Xi PLUS represents the 26th District of Texas and a senior member of the Energy and Commerce Committee.