The mission of the Physicians Research Institute (PRI) is to defend the rights of physicians to determine the best therapy for their patients free from legislative or third party payor interference and to allow doctors to prescribe and/or dispense such medicines as they deem appropriate and necessary for the health, welfare and care of their patients.
One of the principal threats to physician autonomy is the policies of insurance companies. This has always been the case: One remembers the activities of health maintenance organizations (HMOs). In the 1990’s, HMOs were advertised as being the solution to the escalating cost of health insurance. Their principal method of controlling costs was to limit the number of tests and referrals for patients and to discourage doctors from ordering such test and referrals. As it turned out, the “savings” were redirected from healthcare to executive salaries. Very few HMO products are currently popular in the insurance market because of the experience from the 1990s. The only HMO product which remains popular is that offered by nonprofit entities such as Kaiser Permanente. The HMO products offered by “for profit” companies are virtually nonexistent because consumers came to understand that these companies were simply redistributing healthcare dollars to executive compensation or to shareholders.
In 2016, the behavior of HMOs is currently seen in the policies of workers’ compensation insurers and certain health insurers. These insurers seek to limit medical care for injured workers in any number of ways including “utilization review” where proposed medical care and treatment is denied despite the recommendation of the treating doctor. Indeed, there is a “cottage industry” of companies contracting with workers’ compensation insurers to deny needed medical care. These companies will go to any lengths to secure the business of insurance companies as illustrated in this article from Pro Publica.
All of This Because Somebody Got Hurt at Work: Workers’ Comp, Conferences, Expos & Middlemen
Workers’ compensation insurers continue their campaign to limit physician autonomy by securing the passage of restrictive laws and have been successful in 20 states.
Health insurers currently limit physician autonomy in selecting the best medicine for a patient by creating “formularies” which will only pay for certain medicines or engaging in “step therapy” after being forced to take a number of “steps” (less expensive medicines).
PRI will be focused on supporting physician autonomy in the clinical practice of medicine and educating physicians on proposed limitations to their clinical judgment.