New York physician - letter criticizes insurance company patient interference

Health insurance company utilization management programs (e.g. prior authorization and step therapy), can create significant barriers for patients by delaying the start or continuation of necessary treatment, possibly negatively affecting their outcomes. ~ Dr. Peter Ronchetti 

Letter to the editor published in the:

Patient-centered care has emerged as a common goal across the health care industry. By empowering patients to play an active role with their physician in developing individualized treatment plans, this care model can increase patients’ satisfaction and improve treatment quality and outcomes, while reducing or eliminating unnecessary costs.

Despite these clear advantages to adopting patient-centered care, physicians and patients often face significant obstacles in putting this concept into practice.

Health insurance company utilization management programs (e.g. prior authorization and step therapy), can create significant barriers for patients by delaying the start or continuation of necessary treatment, possibly negatively affecting their outcomes. The highly manual, time-consuming processes used in these programs burden physicians, pharmacies and hospitals and divert valuable resources away from direct patient care.

The question is, “who knows best?” Is it a non-physician practitioner at the end of a phone line asking multiple questions? 

Is it an insurance company whose share price goes up as they make more profit from your premiums? The answer is simple: Physicians know best. We were trained to look out for our patients’ best interests. If a patient has disabling arthritis, a mechanical problem with loss of cartilage, who is best equipped to determine the most appropriate treatment? If a physician believes that cortisone injections or physical therapy will improve a patient’s condition to the point they don’t need surgery, then they will order it. The patient does not benefit from the insurance company telling us to put you through painful therapy and/or injections if it will not change the course of the disease.

The concept of prior authorizations should be discussed with the parties involved and not dictated by how much money the insurance company allocates for a given condition, or their idea that a procedure is over utilized.

In fact, this only delays care and costs both the patient and the insurance company more money in the long run.

Patients come to physicians for guidance and trust us to look out for their best interests so why is it that insurance companies do not believe we are doing this? Unfortunately, these bureaucratic bottlenecks do not serve patients and cause wasteful spending in our healthcare system.

Physician leaders in this community should be consulted before broad prior authorization programs are implemented. Monroe County Medical Society welcomes payers to share their concerns with our Quality Collaborative, which is comprised of key community healthcare stakeholders.

What you don’t need are more barriers to accessing the treatment your trusted physician recommends. When you see your doctor next, ask him or her if the treatment you are getting is based on clinical judgment or your insurance company’s protocol. 

If it’s the latter, call your insurance company and let them know “Who knows best”.

Dr. Peter Ronchetti is president of the Monroe County Medical Society.

Now that the eclipse is over - Racism is still with us

Certainly, it's a sad commentary on our nation, built on the exhaulted primcipals of "liberty and justice for all", that we simply can't get over the American Civil War (1860-1865). In fact, the war ended on April 8, 1865 with a surrender by Confederate General Robert E. Lee, in Appomattox, Virginia. So, why do we continue debating about the symbolism left by the very statues and symbols that the Union Army led by Ulysses S. Grant, defeated?

Gernall Ulyssis Grant and General Robert E.Lee at Appomattox Virginia, April 9, 1865

Here's an excellent commentary about this horrible and divisive blot on American history, an "echo" opinion, originally published in the Rochester, NewYork, Democrat.


Editorial: The racism we cannot see

Confederate monuments, like the statue of Gen. Robert E. Lee in Charlottesville, are among the most visible reminders of the barbaric and immoral way in which many of our ancestors built this country.

But, the most dangerous remnants of slavery in America – structural and institutional racism -- are much harder to see.

By virtue of their invisibility, they quietly perpetuate the sins of our nation’s past, unnoticed and unchecked, generation after generation.

After several decades, these subtle remnants now pose an imminent threat to our country’s future. These forms of racism thrive everywhere, but we cannot even look them in the eye and fight back. Americans, regardless of the color of our skin, are woefully unprepared for this battle.

We were not given lessons on these complex subjects in school, even those of us who went on to earn advanced degrees. There are no public service campaigns helping raise awareness or break down these concepts so we can talk about them over dinner. While this Editorial Board has routinely written about these topics as part of our Unite Rochester initiative, it is impossible to do them justice in 525 words or less each time.

A few of us have never heard these phrases, and most of us are unable to provide good definitions or concrete examples. We can’t point them out, so it becomes easy to believe they do not exist. We cannot explain the grave toll they are taking on our economy, our health and safety, and our quality of life. We become defensive, rather than admit our inability to fully comprehend the harm they have wrought on a nation that is supposed to be so much more than it is.

This must change, or these forms of racism will continue to pull us all down!All of us need to be open to learning about structural and institutional racism. Our government and business leaders should be talking about it. Our mass media should be exposing it. Our researchers should be documenting it. Beginning at an early age, our children should be taking lessons on it. We should Google it, read books about it, share articles about it and talk about it.

The YWCA of Greater Rochester sponsors public workshops and other programs that delve into these topics. The Rochester Museum and Science Center often schedules activities designed to help broaden our perspective and understanding on these issues. Several of our community members have a great deal of expertise on the matter, and frequently take part in panel discussions and other public dialogue.


Here are some helpful links to get you started:

A glossary of terms

Rochester Museum and Science Center programming

YWCA of Greater Rochester racial equity programs

Surely, the above links are helpful to those who seek out advice, but it's a shame we still need this level of counseling.

In fact, the Civil War ended April 9, 1865 in Appomattox, Virginia.

Unfortunately, the Civil War ended, the August 22, 2017 solar eclipse came and went, but racism is still with us. 

Labels: Appomattox Virginia, Confederat monuments, Democrat & Chronicle, General Robert E. Lee, General Ulysses Grant