What would you like to change about how you practice urology?

Dr. Davis“The thing I would love to change would be being able to not worry as much about processes and just take care of the patient, to do medicine, and not worry about all the pre-authorizations and all the time we have to spend getting patients through the system. It’s just gotten progressively worse.

Related: How is your practice affected by prior authorizations?

You have to spend a lot of time filling out pre-authorizations; it’s a lot of paperwork. I have a wonderful nurse who does what she can, but the doctor really has to put in the effort to make a good argument if we want to get approval for our patients, and even then there’s no guarantee.  

In particular with the Medicaid population, you just can’t get some things, although it has gotten better in Oregon. But it’s just working around getting authorizations for procedures and medications.

Oftentimes, I have to take time to call the insurance company and do peer-to-peer reviews; first, you have to submit paperwork, and that’s time consuming. Even when they’re eventually approved, it’s hard for the patient; they’re on pins and needles, you’re on pins and needles, so it’s always a tough thing.

The other issue is juggling everyone’s insurance and what each of them allows. You have to try five different drugs before you can get permission to use the one you want. I think most physicians use drugs appropriately, generic and otherwise. When we use a drug that’s expensive, there’s usually a good reason for it.”

Nina Davis, MD

Portland, OR

Next: “What has changed so drastically is having to deal with electronic medical records."

Dr. Bogache“What has changed so drastically is having to deal with electronic medical records. It tends to be somewhat cumbersome, time consuming, and aggravating. It can detract from direct patient dialogue and has prompted the use of more physician extenders and scribes. This introduces another health care provider, which takes away the direct doctor-patient relationship. Unfortunately, this detracts from the physician-patient dialogue and the attempt to focus on providing personal and quality patient care to what we now refer [to] ourselves as a ‘data entry’ person trying to practice medicine at the same time. It’s a common complaint among the majority of physicians, whose frustration with the change has resulted in many early retirements.

Also see: What’s your reaction to CVS/Caremark dropping coverage of Viagra?

There’s no doubt about the fact that EHRs can also be helpful, especially for extracting data. The requirement to use EHRs by the government was intended to be able to easily mine data so they can readjust reimbursement and potentially more easily detect excessive billing practices. It’s also beneficial for practices conducting clinical research trials in terms of being able to easily identify potential eligible patients for studies. It also allows us to quickly list patients with certain urologic issues. This facilitates and allows us to assess outcomes of treatments, develop centers of excellence, and help determine where best to place practice emphasis. As opposed to wading through hundreds of paper charts, we merely click a few buttons, which produces the information desired.

It’s a ‘necessary evil,’ is here to stay, and has certainly changed the way we practice. I just wish there was a better way that wasn’t so distracting from the eye-to-eye contact and the one-on-one relationship with our patients.”

William Bogache, MD

Myrtle Beach, SC

Next: "Health care should be a contract between the physician and the patient."

Dr. Lewis“I think it would be to restore the focus back on the patient/physician relationship and get rid of all of the other distractors-insurances and the financial part-everything that gets in between a patient coming in with a problem and the physician with the training and, theoretically, the tools and knowledge to help them. That simple relationship has become so much more complicated with the current health care environment.

I wish I knew how that could be done-there are so many middlemen and so many people in the way. Health care should be a contract between the physician and the patient. More physician-directed delivery of health care would be a step toward restoring that relationship.

For that to happen, we would have to be the ones driving that and right now it doesn’t seem like physicians are the ones who are organized or empowered or feel like they’re in the position to make that kind of change, and one physician at a time can only do so much. It will take groups of people coming together to make that change.”

Tamra Lewis, MD

Lake Barrington, IL

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