Insurance-directed care has become increasingly worrisome for Choll Kim, MD, PhD, said.
Dr. Kim joined the "Becker's Spine and Orthopedic Podcast" to discuss how insurance and reimbursements have changed over the last decades and how physicians and payers should approach conversations.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: What are some of the biggest issues you're following in healthcare right now?
Dr. Choll Kim: I think the overwhelming thing that really is worrisome is what I call insurance directed care. Over the last 22 years, it's just obvious how every year there's more and more impact of medical decision making based on what insurance companies tell us to do. I find myself and a lot of my colleagues make medical decisions on what type of surgery and what type of care to provide based on what is allowed by insurance companies.
I would like it that we're more physician directed care because that seems more normal, but it has been a relentless kind of progression toward more and more impact of insurance companies. If there's one thing that I'm really worried about, it is how little say we have in medical care as it comes to policy making, and how difficult it is for us to impact that kind of field and in part because payers and insurance companies, they make it very difficult for us to interact with them. I wouldn't even know how to reach them and explain something to them, and when I do these things, what we call peer-to-peers, I've noticed that there's nothing I can say or do to change their mind. Whereas 10 to 15, years ago, they would ask me and they would legitimately care about my opinion.
Patients are unique and different, so that's why we have these doctor-to-doctor interactions. But most of the interactions that I have with another physician that represents the insurance company is more about than just telling me what the policy is and very little about my take on the situation. It's very difficult to convince them that what I want to do for the patient is right. But eventually they will, they will relent because I'm just trying to do what's best for the patient, and they just make us work very hard to get that point across.
And at some point, I can just picture a lot of people just giving up. So we need to figure out a way where we can be more impactful in that whole process, because it should be a team approach. It should not be so adversarial. And I can just tell you, that's the one thing that I feel very unempowered to address. I wouldn't even begin to know how to tackle that problem.