Local Effort to Hold Insurance Companies Accountable Moves Forward
By Jennifer Hartmark-Hill, MD, FAAFP, Board President, American Medical Association
There are few perfect systems in the world. Take, for example, systems of government, the education system, and even our organ systems. No matter how strong and resilient these processes are, they are not without their weaknesses.
The same can be said of our healthcare system, which has its shining strengths and stubborn weaknesses. As physicians, we are well-acquainted with this reality. Many of us dedicate tremendous amounts of time to making positive changes to this system with the goal of delivering the best possible care to our patients.
Of course, we are not alone in this endeavor. There are many organizations, including our professional associations, that are paving the way to a brighter future for health care right alongside us. One great example of this is the Arizona Medical Association’s current effort to reform the medical billing process in Arizona, which is disadvantaging patients and physicians alike.
Over the past several decades, commercial insurance companies have crafted a complex and convoluted medical billing system that drains physician resources and, worst of all, puts the payors in the driver’s seat for patient care. This facet of our healthcare system is fundamentally wrong, in direct conflict with the core principles of patient care, and severely detrimental to our patients’ health outcomes.
The actions of commercial insurance companies are even more damaging given the current reality physicians are working within. Throughout the COVID-19 pandemic, our physician community has been on the front lines, consistently sacrificing our well-being to save lives. At the same time, smaller practices and hospitals have struggled to keep their doors open. Meanwhile, commercial payors have raked in record-breaking profits for their shareholders while raising premiums year after year.
Put simply, when payment is withheld from medical practices in bad faith, it severely impacts practices’ operational capabilities by wasting staff time, resources, and money. This has a direct, negative impact on our patient’s well-being, and we all deserve better.
<--Image caption: Earlier this year, ArMA collected input from Arizona physicians and billing managers on their experience with commercial insurers. Notably, 90%* of respondents reported that inappropriate denials are a significant difficulty for their practice.
*According to survey data collected by ArMA.
As the state’s largest physician-led organization, ArMA has taken the lead in an effort to resolve this issue and bring physicians the relief they deserve. We began by forming a strong stakeholder coalition with the bold goal of bringing solutions to the voters on the ballot this Fall. Ultimately, ArMA's leadership decided that the best route was to bring the issue to the doors of Arizona's State Capitol during the 2023 Legislative Session, and so, preparations for doing just that are already well underway.
Last month, ArMA convened a stakeholder meeting with representatives from 22 healthcare organizations representing hospitals, nurses, dentists, and others within our community. While our interests may diverge on other issues, we stand firmly united in our effort to secure fair payment practices. A consistent, cohesive message from the entire healthcare community will enshrine our credibility on this issue. We are strongest when we stand together.
In addition to rallying our healthcare community, ArMA has already begun to lobby our state’s lawmakers to ensure they understand the urgency of this issue. By meeting with legislators from both sides of the aisle, we can shore up strong support in the legislature, which will be vital to our success. During our meetings, we’ve not only shared the physician community’s perspective on the issue; we’ve also outlined clear solutions for mitigating the issue, which include:
establishing a clear and consistent dispute resolution process that health care professionals can easily access
removing the payor's incentive to drag out negotiations and withhold legitimate payments
adding penalties for insurers that abuse the process and dispute in bad faith
providing the Arizona Department of Insurance and Financial Institutions with adequate funding for employees and resources to enforce the law
reducing administrative burdens through prior authorization reforms
addressing the unscrupulous insurance industry practice of tiering
We have shared and sought input on these goals broadly. To say the community’s feedback on our efforts has been positive would be an understatement. From state legislators to the physician community to key stakeholders to billing managers, the overwhelming consensus is that medical billing reform is needed, and it is needed now. Put simply, this is a fairness issue that anyone can relate to: everyone deserves to be paid what they’re rightfully owed. Truly, this is not a partisan discussion.
Our work is cut out for us in the coming months, but this is a fight worth having, and we are well-positioned for success. The conversation has begun, and we welcome you to be a part of it.
Learn more about Dr. Hartmark-Hill and Arizona Medical Association (ArMA)
Jennifer Hartmark-Hill, MD, FAAFP, is an Associate Professor & Director of Narrative Medicine at the University of Arizona, College of Medicine - Phoenix. Dr. Hartmark-Hill graduated from the University of Arizona, College of Medicine - Tucson, and completed her Residency from Mayo Clinic, here in Arizona. She currently serves as Board President for ArMA and past board member at Maricopa County Medical Society (MCMS).
The Arizona Medical Association (ArMA) is the largest organization in the state representing the interests of all physicians. Since 1892, ArMA has been advancing patient care and providing its members channels for leadership, advocacy, education, and community. For more information, visit AZmed.org and follow ArMA on Facebook, Twitter, and LinkedIn.