Expand access to healthcare by limiting third-party interference
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As lawmakers re-evaluate avenues to successful healthcare reform, they must not overlook the urgent need to protect the doctor-patient relationship. Expanded access to healthcare is meaningless unless lawmakers address third-party disruption in potentially life-saving medical treatments.

We are at a frightening precipice in the doctor-patient relationship where third parties have more power in the exam room than the doctors treating their patients. At a time when the importance of empowering patients in medical decision-making is being recognized, third-parties are practicing unprecedented interference. This allow payers to have the ultimate authority over whether or not a patient will receive access to treatments that doctors have already deemed necessary.

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The doctor-patient relationship is a partnership first and foremost. The patient is the center of the medical universe and doctors are taught to recognize the importance of this collaboration. However, the insurers responsible for determining patients’ access to treatments and medications recommended to improve their health – or to even save lives — do not possess the same acuity. 

 

In particular, minority communities are facing a lack of access to necessary treatments. Without improved health literacy and a greater understanding of medical ailments, patients often aren’t aware of their rights. Many patients without access to this information do not know that when insurers deny them access, they can appeal and fight for the treatments their doctors feel are most appropriate. 

While it may be surprising to hear that patients are denied treatments their doctors have prescribed, these practices are fairly common. For example, step therapy requires patient to fail first on a less expensive medication, even if it is likely to be less effective. Obstacles to overturning insurers’ denials may deter patients from pursuing claims, cause them to think that it is too difficult to fight for themselves. Doctors and patients must be encouraged to do everything possible to keep medical decision-making in the hands of patients and the treating physicians.

As a cardiologist, I observe this injustice on a weekly, and sometimes daily, basis. For example, individuals with cholesterol issues, hereditary heart failure and statin intolerance, there is now a class of medication called PCSK9 inhibitors that help lower cholesterol when statins have failed. However, many heart patients, especially those in the African American community, have struggled to obtain access to PCSK9 medication.

We have also witnessed this with heart failure treatments for African American patients. Many patients who qualify with severe congestive heart failure have been denied lifesaving treatments. It is increasingly difficult to serve and protect patients when doctors cannot easily treat patients that are in need. 

This stands in direct contrast to basic medical principles. It is unethical to deny treatment for a patient, particularly when other treatments have proved to be ineffective.

Rather than determining whether a medication is beneficial for the insurance company’s bottom line, the relevant question should — will it improve or save the patient’s life? Reconciling this priority with those of the insurance carrier is untenable.

Instead, doctors are now finding themselves in a triage situation designed to make patients independently prove they require a treatment or a medication. Decisions to approve treatments must be based on the conclusion of a doctor using diagnostic procedures and lab studies to render such a conclusion.

It is unconscionable to deny patients a treatment that has proved to work, be effective, and save lives. It’s time for doctors and patients to stand together so that patients not only know their rights but can access their medications. Collectively, they must strive to restore the sanctity of the doctor-patient relationship, and advocate for an end to third-party interference.

Dr. Richard Allen Williams, M.D. is the President of the National Medical Association, and a renowned cardiologist. A graduate of Harvard University and the State University of New York Downstate Medical Center, he is also a founder and board member of the Association of Black Cardiologists, and the President of the Minority Health Institute.


The views expressed by contributors are their own and are not the views of The Hill.