Should an insurer or a doctor decide where your care takes place?

Every day, physicians, patients, and the families who care for them make hundreds of decisions together about where and how care should be delivered. Those choices reflect what matters most to the patient and family, alongside clinical expertise, patient safety, medical complexity, and access to the resources needed to achieve the best possible outcomes.

Increasingly, however, these collective judgments are being second-guessed — and often overruled — by large insurance companies through policies that prioritize administrative convenience and cost-shifting over clinical judgment and the needs of the people receiving care.

At Jefferson, where I am chief physician executive, we believe healthcare decisions should be made by patients, their families, and their care teams — not by insurance company policies that create barriers to treatment.

That is why we are speaking out against a growing number of managed care policies, including recent actions by Independence Blue Cross, that delay care, increase administrative burden, and interfere with the ability of physicians and patients to determine together the most appropriate setting for treatment.

Supporters of these policies describe them as efforts to control healthcare costs, but they have the opposite effect — at the expense of patient access, clinical judgment, and safe care delivery. When insurers insert additional layers of authorization, site-of-care reviews, exception requests, and excessive documentation requirements into the care process, the result is not greater value. It is greater friction.

For patients and families, that friction can mean postponed procedures, unexpected changes in where care will be received, canceled appointments, additional paperwork, and uncertainty at a moment when many are already carrying the weight of a serious diagnosis.

Families rearrange work schedules, travel plans, childcare, and other responsibilities around a procedure date — and then learn the date has moved for reasons that have nothing to do with the patient’s medical condition. Too often, patients and families are the last to know that a decision about their care is under review, and they are given little explanation of who made it or why.

That is not information sharing. It is not participation. And it does not reflect the dignity and respect patients and families are owed as full partners in their own care.

For physicians, nurses, and the rest of a care team, it means spending valuable time on administrative requirements rather than at the bedside, answering the questions patients and families actually need answered.

The IBX Site of Care policy is one example. Under this new rule — which was implemented in June — certain procedures that have long been performed safely in a hospital outpatient setting must now undergo additional review that goes beyond determining whether the care is medically necessary. Physicians may need to prove why a patient cannot receive care in an alternative setting, submit exception requests, supply additional documentation, and navigate new administrative workflows before treatment can proceed.

These requirements may sound modest on paper, but their cumulative impact is significant. They create new administrative costs that do not improve the quality of care, require additional staffing and resources, slow scheduling, and increase the likelihood of delays and disruptions for patients and families.

Patients and families deserve a healthcare system that removes barriers to care rather than creating new ones.

Particularly concerning is the effect on high-volume services such as colonoscopies and other diagnostic procedures that are essential to prevention and early detection — the very care that keeps families healthy and catches disease when it is most treatable.

This issue extends far beyond a single insurer or policy. Across the healthcare industry, patients, families, and their care teams are confronting an expanding web of insurer-imposed administrative requirements: prior authorizations, repeated documentation requests, portal submissions, denials, appeals, and site-of-care restrictions. Each requirement consumes time, resources, and attention that could otherwise be devoted to care itself.

The question policymakers, employers, patients, and families should be asking is a simple one: Are these requirements improving care, or are they simply making care harder to access?

» READ MORE: IBX and Highmark want to cut costs by moving more outpatient care to surgery centers

Patients and families deserve a healthcare system that removes barriers to care rather than creating new ones. They deserve to be told, clearly and promptly, when an insurer’s policy is affecting their care, and to have a real voice in decisions about where and how that care is delivered.

Physicians deserve the ability to exercise clinical judgment, in partnership with patients and families, without unnecessary interference.

And health systems should be able to devote their resources to caring for patients rather than navigating ever-changing administrative mandates.

Jefferson supports accountability, transparency, and responsible stewardship of healthcare dollars. But we will continue to challenge policies that place insurance company bureaucracy between patients, families, and the care they need.

Healthcare works best when decisions are guided by medical expertise, in partnership with patients and families — not by administrative hurdles that add cost, complexity, and delay without improving outcomes.

Edmund Pribitkin is chief physician executive and executive vice president at Jefferson Health.