Issue link: https://beckershealthcare.uberflip.com/i/1535653
12 THOUGHT LEADERSHIP It's disheartening to see clinical decisions being dictated by insurance algorithms instead of medical expertise. is not only delays care but oen compromises the quality of care patients receive. A meaningful change would be a system that empowers physicians to make evidence-based decisions without unnecessary interference—where the patient's health comes first. at said, I'd also be transparent about the demands of the journey. e training is long and rigorous, and the daily practice of medicine comes with significant emotional and systemic challenges. What's shaped my perspective most are the moments when I've been able to restore a patient's vision, guide a family through a difficult diagnosis, or witness a recovery that felt almost impossible. ese are the moments that keep you going — they remind you why this calling is worth it. Christopher Mattern, MD. Orthopedic Surgeon at White Plains (N.Y.) Hospital: Reducing the burden imposed by the healthcare bureaucratic state (eg, prior authorizations, endless clicking in an EMR that interferes caring for patients, endless hoops to jump through that are put in place by those not directly caring for patients). It really is time for a reset in medicine to return the focus on patients and the doctor's ability to care for them. James McLoughlin, MD. Spine Surgeon at Ivy Spine & Orthopedic Specialists (Panama City, Fla.): e power structure in healthcare is out of balance. Private insurers and private equity investors have far too much influence, and it is growing with medicare advantage plans. At this point, care is frequently compromised by these external forces. e only legitimate way to continue to support the idea of private health insurance and private equity investment is to level the playing field. Such leveling would require coverage of a good-faith Rx med and/or a diagnostic study or treatment if prescribed by a board-certified physician in a specialty that customarily covers the Rx'd med/study/ treatment. Coverage and/or authorization should guarantee timely payment. Period. Failure to provide such financial coverage should immediately transfer the malpractice and any other liability to the insurer, as they are financially over-ruling the medically planned care, and should therefore assume the risk associated with THEIR decisions. Next, I would recognize that statements made to insurers which are deemed inaccurate can be prosecuted as financial fraud; since insurers can claim this of providers, providers and patients should be able to claim the same fraud if inaccurate statements are made to the patients or to the providers by the insurer. A level playing field. With damages available. A percentage cap on spending for all else than actual care for insurers. Administrative functions, advertising and other non-care (all payments made to any entity that is not an actual care provider to the patients) expenses should be bundled and capped at 10% total — 90 cents of every healthcare dollar needs to go to healthcare. Lastly, an open agreement should be required of health insurers — stating unequivocally that their primary role and primary responsibility is to finance healthcare in the U.S., and NOT to provide reimbursement to their investors. is last one is most important, because it changes the philosophy to one of medicine above business instead of the other way around. Insurers that refuse this should be shuttered. If all insurers close or refuse, simply replace them all with medicare for all. at should be their only chance for existence, as they have siphoned off too much revenue for too long for executives — all the while leaving American patients and providers without solutions — and doing it all electronically from their yachts. It is time to fix this mess. Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach (Calif.) Lakewood Orthopaedic Institute: One impactful change would be the integration of real-time, AI-assisted clinical support tools directly into the EMR — not as an aerthought, but as a seamless part of our workflow. Orthopedic surgery is increasingly data- driven, from imaging to outcomes tracking, yet we're still burdened with fragmented systems that require extra clicks, manual data entry, and time away from patients. A smart, intuitive system that pulls in relevant imaging, flags critical labs, tracks recovery milestones, and even dras templated op notes or follow-up plans based on intraoperative findings would transform the way we practice. We shouldn't have to choose between being thorough and being efficient — we can be both, with the right tools. Ultimately, the goal is more face time with patients and less screen time. Bringing tech into the OR and clinic in a way that actually helps rather than slows us down would be a small change with a huge ripple effect. Ken Sandin, MD. President of Excellence in Rehabilitation Medical Group (Santa Barbara, Calif.): Irrespective if the doctor is self-employed, an employee or partner of a single or multi-speciality physician- owned practice, employed by a hospital or health system physician enterprise, or in some other work structure, managerial support for and encouragement of maximal autonomy for (clinical) decision making and task management will improve my day-to- day life. Tom Shaffrey, MD. Family Physician in Bound Brook, N.J.: Legislation reducing the overwhelming powers given to commercial insurance companies and removing the profit motive of for-profit companies. Marc Shelton, MD. Associate Professor of Medicine in the Division of Cardiology at the University of Missouri Health: e thing I miss the most and the one that would most significantly improve my day-to-day experience as a physician would be to get back to the days when we handle outpatient clinical issues consistently as a dyad with an RN who also knows the patients and can quickly help as issues arise. Physician order entry sounds great in theory, but 17 clicks to order a stress nuclear study is a hard situation to love. Lance Wobus, MD. Psychiatry Resident at Richmond University Medical Center (New York City): As with many physicians, documentation is a huge drain on my time and resources. As I'm oen told, "If it isn't documented, it didn't happen." at means much of the day I'm recapping earlier events rather than spending time on new clinical work. I'm very positive about AI helping in this regard and have been following the literature and trying out a few platforms. If this can be standardized and streamlined in practices and the learning curve flattened, it will be a monumental improvement to patient care. Vivek Yadav, MD. Assistant Professor of Medicine at Mercer University School of Medicine (Valdasota, Ga.): Integrating advanced electronic health record systems with enhanced interoperability and user- friendly interfaces could be another significant change to improve the day-to-day experience for physicians. By streamlining the documentation process, reducing redundant data entry, and ensuring hassle free communication between different healthcare systems, physicians can save time and reduce administrative burdens. Ultimately, this change can lead to increased efficiency, allowing physicians to focus more on patient interactions and less on paperwork. n