MAOPS Physician Survey Supports Need for Missouri Senator Kurt Schaefer’s Bill

In efforts to give Missouri physicians the ability to care for their patients, increase transparency in the healthcare system, and limit non-medical interference in patient care, the Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) will work to help pass Senate Bill 236 (SB236), filed by Missouri Senator Kurt Schaefer.

If passed, SB 236 will increase the transparency of prior authorization and step-therapy protocols of pharmacy benefits managers (PBMs). These protocols force patients to use generic substitutes or to try completely different medications than their physician prescribed, often without the patient and/or physician being aware. These protocols delay treatment, lead to poor health outcomes in patients, and are strictly cost-saving measures for insurance companies.

MAOPS President Kevin P. Hubbard, D.O., stated “Missouri patients are denied high quality medical care when insurance companies mandate prior authorization of medications and treatments and when they require fail-first treatments where patients must fail on a drug or treatment before the physician prescribed treatment is approved. Physicians are concerned that the physician-patient relationship is being seriously restricted.”

Senator Schaefer’s bill comes just months after MAOPS conducted a survey of its members which showed almost universal dissatisfaction with insurance company protocols such as prior authorization and step-therapy. The survey results mirrored those of similar surveys done in New Jersey, South Carolina, and by the American Medical Association.

The MAOPS survey results show that physicians are almost in universal agreement that insurance company protocols like those described above affect their ability to care for their patients at the highest level. Specific findings of the survey include:

v 94 percent of Missouri physicians surveyed said health insurer protocols like prior authorization and step-therapy had a “somewhat” or “very’ negative effect on their ability to effectively treat patients.

v Almost 94 percent of survey respondents stated health insurance companies in Missouri delayed or denied prescription medications or diagnostic testing for their patients.

v Over 99 percent rated their overall experience with insurance company interactions regarding pre-approval, step therapy, or similar protocols as at least “somewhat: burdensome, with almost 25 percent indicating they were a “major hassle.”

v 68 percent of physicians responding stated they “frequently” were concerned that insurance company protocols like prior authorization and step-therapy negatively impacted their ability to provide the best possible patient care, with another 27 percent stating that this was “occasionally” the case.

v Almost 50 percent of responding physicians stated that the “hidden costs” associated with meeting health insurer protocols have a “significant to crippling” impact on their practice, and 83 percent stated the protocols had at least a “moderate” impact.

v Over 58 percent of survey respondents indicated they had considered leaving the profession, early retirement, or a fee-for-service practice to avoid or minimize the administrative work associated with insurance company protocols like prior authorization and step-therapy.

MAOPS President Kevin P. Hubbard, D.O., states that “health insurer protocols delay treatment for sick patients and cause a tremendous administrative burden on physicians and office staffs. Often, the physician is spending time trying to obtain approval for a medication or therapy, taking away time they could be spending on patient care.” As an example, one physician has a staff member dedicated solely to the task of dealing with insurance companies. Another, as of January 1^st, is no longer accepting insurance of any kind and all patients are required to pay at the time of service. Yet another reports he may have to give up his geriatric practice due to the burden of insurance company protocols.

In response to the survey results, MAOPS is mobilizing its members through its D.O.c.-A-Day program, in which physicians spend a day at the state Capitol raising the awareness of legislators about issues affecting the medical profession and patient care. Hubbard states that this year Senator Schaefer’s bill will be a priority for MAOPS. The bill protects the autonomy of the physician-patient relationship, increases the transparency of insurer protocols, and places the final decision-making authority with the physician, not an insurance company.

For complete survey results, please visit: http://maops.affiniscape.com/displaycommon.cfm?an=1&subarticlenbr=227