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The Business of
Health Care Report Physicians as patient advocates is the best of all worlds. In the past, a physician ordinarily made a decision involving medical treatment and patient together -- based on the risks, successes, side effects, and recovery. However, managed care has added a third party to the decision process for both routine and more sophisticated care. Physicians now must exercise greater involvement serving as advocates for what is best for their patients. Let's use as an example, a new back surgery. First, it has required enterprising, inventive physicians somewhere to convince managed care companies that the new procedure is better than the one formerly used. The goal is to get it on the list for payment by the insurer as an option or standard of care for the diagnosis. Yet that doesn't mean the procedure will be approved for all patients. Furthering our scenario, let's say the physician thinks this new back surgery is best for this patient, John Doe--best at relieving chronic pain, shortening the operating time, and certainly giving the patient greater mobility after recovery. The cost, however, is $5,000 more than the traditional procedure, which the insurer believes is equally effective for John. Documentation and many phone calls to a case manager or medical director at the managed care company may be required to reach agreement on John's course of care. Now, let's say John has had the advanced surgery and is now recovering but still needs pain medications. The medication the physician's experience believes is best is not on the patient's pharmacy formulary through his insurance. Again, the physician as an advocate for John must generate letters and phone calls to get an exception. The job of patient advocate is not an easy one and is becoming more time-consuming. But it's a job consumers respect and appreciate in their physicians. If you have comments on health care or suggestions for topics to be addressed on this program, e-mail me at DougHawthorne@TexasHealth.org. Stay tuned to our weekly Business of Health Care reports here on TexasHealth.org and on News Radio 1080 KRLD. Doug Hawthorne - DougHawthorne@TexasHealth.org ©
2001 Texas Health Resources |
