Faced with an opportunity to advocate for patients, Rajeev Jain, MD, AGAF, is never afraid to speak up. He recently spoke out publicly against a major payer’s new advance notification process for colonoscopy and endoscopy procedures, cautioning it was a glidepath toward far-reaching prior authorization requirements.

UnitedHealthcare plans to collect a larger scope of data for this new policy, “which I fear will disrupt and deny patients’ access to lifesaving care,” Dr. Jain, a gastroenterologist with Texas Digestive Disease Consultants and a member of the American Gastroenterological Association’s (AGA) Prior Authorization Reform Task Force, wrote in an opinion piece in the Dallas Morning News.

Insurance coverage should be fair to the end goal of taking good care of patients, said Dr. Jain. “And if they’re putting processes in place, which are solely to be an impediment to excellent care, then that’s not right.”

Through his extensive participation in AGA panels and other influential groups, Dr. Jain has sought to improve clinical practice and reduce physician burnout. As Director and now Chair of the Board of Directors” of the American Board of Internal Medicine, Dr. Jain participated in conversations to make the maintenance of certification (MOC) process more accessible and less burdensome for doctors.

People spent a lot of time studying for ABIM’s 10-year MOC exam, sometimes even taking a course to help them pass. Now, there’s an option in all specialties to take a 30-question exam every quarter.

On average, it takes someone roughly 2 minutes to answer each question on this short exam. “Per quarter, you’re roughly spending an hour to do that instead of taking a big 10-year exam, where people were spending money and missing work,” said Dr. Jain. This modality enables physicians to meet credentialing requirements “in a way that it meets many of the desires of our practitioners,” he added.

Dr. Jain expounded on his work to advocate for patients and physicians in an interview.

Q: I’d like to discuss your opinion piece on UnitedHealthcare’s advanced notification process. Where does that policy stand now? I’m wondering if your opinion piece led to any changes.

Dr. Jain: There’s not a metric I can use to measure its success. But I will tell you this: I’ve had numerous patients mention to me, “Hey, I saw your article in the Dallas Morning News. That was great.” And that would lead to a conversation.

Q: Why do you think UHC’s policy was a tool for prior authorization?

Dr. Jain: Imagine you go to see a gastroenterologist in clinic, and the GI believes you need a procedure for certain symptoms or abnormal laboratory tests or imaging. It’s not a screening procedure. It’s a diagnostic procedure. Now, the insurance company is going to say, “Well, we can’t schedule that until you do a preauthorization.”

That could take a day. It could take a week. It could take longer. And now, the patient has lost that moment where they can get this settled. It’s not just the schedule for the patient. They’re going to get anesthesia, be it conscious sedation or deeper sedation, and they’re going to need a ride home. They have to coordinate things with family members or friends. Those little logistics add up to a lot of times why patients cancel or don’t show up or don’t follow through, because we couldn’t get it scheduled at that moment.

I feel like we are trying to attack this problem from many different angles, and my opinion piece was one of those tactics. The patients and the rank-and-file gastroenterologists appreciate the AGA being at the forefront of this issue.

Q: Your interests range from colon cancer to Barrett’s esophagus and inflammatory bowel disease (IBD). Is there an area of focus you feel passionate about?

Dr. Jain: Through AGA, I was the cochair of the IBD Parenthood Project, which convened subject-matter experts outside of GI, including maternal-fetal medicine, lactation experts, and patients. We came up with a care pathway for women in their reproductive years who have inflammatory bowel disease, including how they should think about family planning and what they should do during pregnancy and then the postpartum. Those kinds of things have really kept me energized. It’s sort of an antidote to burnout.

Q: Who are your mentors?

Dr. Jain: I would say the late Dan Foster, MD, who was the chair of medicine at UT Southwestern, and Mark Feldman, MD, AGAF, who held leadership roles at the Dallas VA Medical Center and then Texas Health Dallas. He retired a few years ago. They both expected physicians to understand the knowledge of how we were taking care of the patient and our professionalism. There’s also my senior partner, Peter Loeb, MD, AGAF, who’s now retired. He had an insatiable appetite for knowledge. Every time I’d come back from a meeting, he’d say, “Rajeev, tell me three things you learned.” He always kept patients as the primary North Star; that whatever we did, we were thinking, “Is it best for the patient?”

Lightning Round:

Favorite type of music?

1980s alternative

Favorite movie genre?

Comedy

Cat person or dog person?

Dog

Favorite sport:

College football

What song do you have to sing along with when you hear it?

“I Ran,” by a Flock of Seagulls

Gastroenterologist advocates for fair coverage, reduced physician burden

Lightning Round: