The RBV Blog

The people, products, and ideas shaping healthcare today – by Dr. Richard Vanderveer, Chief Innovation Officer, ThinkGen

Insurance Denial

December 6, 2018

A week or so ago we talked about the “joys” of insurance companies requiring “preauthorization” for the use of medications. At the proverbial Bottom Line, we pondered the impact that delays and other short circuits could have on the quality of the medical care delivered.

Here we go again. This blog post by a “whistle blowing” physician considers this issue from the extreme case to the day-to-day. More specifically, it begins with the report of a jury awarding $25 Million to the family of a cancer patient that was denied access to a medication and later died.

At a more prosaic level, the article goes on to describe a “step therapy requirement,” that is not an absolute denial but rather will authorize a more expensive medication only if less expensive alternatives have failed. Got me to thinking. In virtually every study we do at ThinkGen, we hear physician reports of this requirement and the impact that it has on their practices. What impact? Oh, little things. Like hours of paperwork and the delay of the care which the doctor believes to be optimal.

In this latter regard, check out the blogging physician’s tongue in cheek speech that he would recommend that a doctor faced with this set of circumstances might give to the patient:

“I prescribed a medication to you that my training and experience informs me is the best choice for you. Instead, let’s spend the next few months giving you some different medicines, just for fun. I don’t think this medicine really makes sense in your case; that’s why I didn’t prescribe it. Your insurance company, who always has your health and welfare as its highest priority, want us to wander off course for a while. Who knows?  Miracles happen. Maybe the stuff might work by accident. No need to fret too much.  Eventually they will give in and you will ultimately get the right stuff covered. And think of all the quality time the two of us will enjoy on our journey together!”

Right on! 

Also, not to be ignored in his post are the blogger’s musings as to whether or not the real purpose of the step therapy requirement is to make doctors and patients give up and go away. Interesting and bothersome notion.

Bottom Line. Like we said at the conclusion of our last blog post on this topic, the unintended (and intended?) consequences of preauthorization and step therapy requirements are profound. Give them some thought, and figure out what you would do about all of this if you were a physician who was “Czar of all of Russia?” Or, the CEO of a medical insurance company that considers every dollar it spends on patient care to be a ding in their profitability?

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Richard Vanderveer, Ph.D.

In addition to his blog, Dr. Vanderveer has written numerous articles on innovation in healthcare marketing and marketing research - not only to challenge new thinking, but also to provide specific and practical advice.

Insurance Denial

December 6, 2018

A week or so ago we talked about the “joys” of insurance companies requiring “preauthorization” for the use of medications. At the proverbial Bottom Line,

Risky Signatures

December 5, 2018

Check this out. What you will see is an unfortunate farce, one of many in U.S. healthcare in 2018. More specifically , you will see

Paying Attention To Patient Modesty

December 4, 2018

Interesting. In the years I have been writing this blog, I don’t believe that I have typed in the word “modesty” even once. BUT. Check

Death By Prior Authorization

November 29, 2018

Huh? Check this out. What you will see is a very disturbing blog post. In it, you will see reportage of a case in which a

Rating The Ratings

November 28, 2018

Check this out.  What you will see is a doctor who is clearly and understandably disenchanted by the extent to which everything in healthcare is

Health Insurance Is Not Enough If You Are “Really Sick”

November 27, 2018

Check this out. What you will see is a NYT story reporting the findings of a survey that investigated the experiences of almost 1,500 people

Flirting With Functional Medicine

November 21, 2018

Check this out. What you will see is a riff by our old friend The Country Doctor, pictured above, on the topic of functional medicine.

Potus Vs. Amazon

November 20, 2018

Check this out. What you will see is the musings of a physician who is pondering what will happen with the troika that Amazon/Berkshire Hathaway/J.P.

Why Do Doctors Hate Their Computers?

November 15, 2018

Check this out. What you will see is not the quick blog post that I usually send you to for a quick burst of profundity.

Human Inconvenience

November 14, 2018

Check this out. What you will see is a brief and insightful post about how little tolerance people have for inconvenience. When it comes to

How To Avoid Being A “Robot Doctor”

November 13, 2018

Check this out. What you will see is the story of a first-year medical student who desperately wants to avoid becoming a “robot doctor.” She

Ah, Maria Yang

November 8, 2018

We have forwarded you to her posts before. Here we go again. Maria has an uncanny ability to share with us the nuts and bolts

Sex, Gender, Discrimination And A “Public Health Crisis”

November 7, 2018

Check this out. I have read this piece several times, and must admit that with each reading, I become increasingly confused. I know I have

Burnout And Finances

November 6, 2018

Check this out.  What you will see is an interesting post from a blogging physician whose page carries a message of “Wealth and Wellness.” He

Back To The Future

November 1, 2018

I present for your consideration a very interesting, make that sort of shocking, blog post. Here, you will see a physician very understandably and vociferously

The Risks That Come With Assembly Line Medicine

October 31, 2018

Check this out. Very reasonably, this blog questions whether medical practices should operate at the same speed as delicatessens do, grinding out patients/sandwiches as quickly

THE FIVE THINGS DOCTORS FEAR THE MOST

October 30, 2018

Check this out. What you will see is an insightful discussion of the five most prominent fears that bedevil doctors. They include: Peniaphobia: The fear

THE "COMMON SENSE FAMILY DOCTOR” COMMENTS ON EVIDENCE BASED MEDICINE

October 25, 2018

Check this out. What you will see are some interesting observations on EBM by a family physician who is also a professor who teaches public

SEVEN OUT OF TEN DOCTORS . . .

October 24, 2018

. . . wouldn’t recommend that their kids become doctors! Check this out. What you will learn is that in a national survey of over

The Disruptive Physician

October 23, 2018

Check this out. You will suddenly find yourself immersed in a site dedicated to making sure that doctors in training don’t have to put up

Helping Doctors To Balance Their Lives

October 18, 2018

Check this out. What you will see is a site, hosted by a female physician, dedicated to helping other lady doc’s to strike a suitable

Is It Doctor, Or Is It “Julia?” What’s In A Name???

October 17, 2018

Check this out. What you will see is an article that at first glance seems to be sort of vapid. Female physicians tend to be

A Cardiologist Comments On The New Apple Watch

October 16, 2018

And he comments with some skepticism. Of course, he is the “Skeptical Cardiologist.” Check this out. What you will see is a physician wrestling with

The Pharmacist Is A Whore

October 11, 2018

When I got into this business a gazillion years ago, we used to do studies with pharmacists rather regularly. BUT. I haven’t really even thought

Doctors Do Podcasts

October 10, 2018

I don’t want you to spend a lot of time on this. Just give “DOCS OUTSIDE THE BOX" a quick scan and listen. Why?  Here is a

THIS COUNTRY DOCTOR IS A WISE DOCTOR INDEED!!!

October 9, 2018

He may be a country doctor, but he makes a lot of very good points in his posts. And this an especially good one. In

“Starting to See Some Light”

October 4, 2018

Check this out. What you will see is one doctor’s take on “First Do Not Harm,” the new movie that I have referred you to

Enhancing Physician “Visibility”

October 3, 2018

Check this out. What you will see is a 5-step guide to help physicians to increase their “visibility.” To help them to better “brand” themselves.

Attaching a Face to Physician Suicide

October 2, 2018

I’ve written time and again about physician suicide, and the widespread burnout for which it is the ultimate last step. To my amazement, many of

Sex, Cars, Money, And Dementia

September 27, 2018

Check this out. What you will see is a very thought-provoking article by a physician whose professional work centers on the field of bioethics. Seems

Behavioral Economics And The Practice Of Medicine

September 26, 2018

Check this out. What you will see is a family physician’s very practical recounting of how to avoid two biases, originally uncovered by Behavioral Economists,

Disappearing Medical History

September 25, 2018

Check this out. What you will find is a strange story of what has recently happened at Brigham and Women’s hospital in Boston. Seems that

Has Medicine Moved From Being Patient-Centered To Being Profit-Centered?

September 20, 2018

At least one blogging physicians thinks that it has. Check this out. This post sort of goes on forever, but its message is actually a

Behavioral Economics Goes To Medical School

September 19, 2018

Check this out. Sorry folks, it’s not an article or a blogging physician’s post for you to look at this time. Nope. It is a

Prediction: “Habit” Will Replace “Decision” As The Focus Of Healthcare Marketing In 2019!!!

September 18, 2018

Huh??? Check this out. What you will find is a book that you should download to your Kindle and read. Right away! Why? Because! I’ve

Why “Bother” To Offer That Patient A Clinical Trial???

September 13, 2018

Several years ago, I made a presentation at what at the time was still PMRG (now Intellus) with a gentleman named Ross Weaver. (clinicalscore.com) Ross’s

Emergency Medicine: A Sizzling Hot Specialty That Can Fry You To A Crisp!!!

September 12, 2018

Interesting piece. It seems that it is now commonly known, and even common sense, that ER Docs are burning out like crazy. We’ve talked about

It’s Not Just Doctors And It’s Not Just Burnout!!!

September 11, 2018

Check this out. What you will see is a piece that starts off by reporting a death by suicide. Not of a doctor. Of a

Individual States and The Federal Government vs. Pharmaceutical Company Pricing???

September 6, 2018

Check this out. What you will see is that many individual States are writing laws aimed at controlling drug prices. Medicaid programs, which are funded

A Real Game Changer!!!

September 5, 2018

Check this out. (Skip the advertisement!) What you will see is a real game changer. The announcement that NYU will no longer charge tuition for

These Three Factors May Explain Physician Burnout

September 4, 2018

Check this out.  What you will see is a thorough, if unsurprising, explanation of the apparent causes of physician burnout. As I read this article,

Locum DOC

August 30, 2018

Check this out.You will read the story of a fork in the roads. A doctor who decides to quit a full time “job” and begin

Our Buddy The “Country Doctor” Reads The Harvard Business Review???

August 29, 2018

Yes, he does! Check this out. What you will learn is that this MD in rural Maine has figured out something rather important. You see,

Physician Startup CEO’s

August 28, 2018

How do these words fit together, and why is their confluence so important? Check this out. What you will see is an article written by

What the CEO Knows!!!

August 24, 2018

Note: The first half of this blog was delivered on Tuesday, August 14. While half a blog is not necessarily better than none . . .

Medical School Side Hustles

August 21, 2018

  Note: The first half of this blog was delivered on Tuesday, August 14. While half a blog is not necessarily better than none . .

What the CEO Knows!!!

August 16, 2018

Check this out. What you will see is an invitation to attend a seminar conducted by a former hospital CEO. What will you learn? Everything

Reading Patient Body Language

August 15, 2018

Check this out. What you will read/see in a video is a Manhattan physician telling his colleagues about how to read body language in their

Medical School Side Hustles

August 14, 2018

Check this out. What you will see is a list of side hustles that a financially sophisticated doctor proffers as being workable for medical students.

Three Financial Enemies of Physicians

August 9, 2018

Check this out. What you will see is a post by the “White Coat Investor,” pictured above. Jim Dahle is an ER doc who got

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