Five physician leaders joined Becker's to discuss the payer behavior they'd like to see changed in 2024.
Question: What payer behavior would you like to see changed in 2024?
Editor's note: These responses were edited lightly for clarity and length.
Clarissa Arthur, MD. Family Medicine Physician in Nashville, Tenn.: The payer behavior that our providers would like to see includes the return of coverage for telehealth encounters, by BCBS and Cigna. Presently, telehealth visits are not covered items. This is because telehealth was seen by these insurers as a COVID-19-related necessity or convenience. They inaccurately concluded that with less virulent strains of covid and less mortality, this was no longer a necessary service. Very inaccurate, as patients and/or their families (as pertains to our more mature population) have a great appreciation for this service.
Loay Kabbani, MD. Vascular Surgery Specialist for Henry Ford Health (Detroit): Sadly, one of the greatest time-consuming requirements is prior authorization. I would love to see streamlining and expediting the preauthorization process. I have to routinely delay a case or get close to canceling it, in addition to all the time that is spent by my office staff and hospital staff to get all the needed preauthorization material.
Udaya Bhaskar Padakandla, MD. President of Texas Society of Anesthesiologists:
1. I would like to see them remove/eliminate ALL prior authorization of patient care. It has now become crystal clear that PA is a tool they have unleashed to contain costs and maximize their profit margin, and have absolutely nothing to do with improving the healthcare of the patients. Patients are the primary victims of the compromise in healthcare and providers are the collateral victims by means of denied payments and delayed payments.
2. I would like to see them play a fair and honest game in disclosing ALL the factors that are involved in calculating the qualifying payment amount as part of compliance with the No Surprises Act. Transparency at all levels of payer involvement is sorely missing (be that PBM payments, GPO deals, pharmacy benefits, or electronic transaction fees).
Joan Richardson, MD. Professor and Chair of the Department of Pediatrics at University of Texas Medical Branch (Galveston): I would like to see less emphasis on prior authorization.
Christopher Walker, MD. Physician in Chief of Kaiser Permanente Napa-Solano (Vacaville, Calif.): The continued leaning of payments for Medicare Advantage and for our sickest patients. With the increase in illness burden, utilization and soaring drug/labor costs, I’m very concerned that patients will be impacted in an adverse way, especially in systems that depend strongly on preauthorization and utilization management.