The Power of Pain Foundation is working on a bill in AZ to help correct the practice of Prior Authorization abuse by insurers.
January 6, 2012 at 4:18pm
The article below was done by Dr. Todd Levine. We are working w/ him and Senator Michelle Reagan to get a Prior Authorization bill passed in Arizona in the 2012 session. More info to come, but I wanted to share this piece from the Phoenix Business Journal.
1/6/12 My View: Prior authorizations should be rethought in 2012 – Phoenix Business Journal
http://www.bizjournals.com/phoenix/print-edition/2012/01/06/my-view-prior-authorizations-should.html
My View: Prior authorizations should be rethought in 2012
I read with great interest the recently published health care innovation section published in the Phoenix Business Journal, and for me it inspired further reflection on other opportunities for improvements. Certainly given the economic climate, enhancements are in demand, as every business is simplifying and streamlining its methods as a consequence of the recession. Physician practices are no different, which is why burdensome processes such as “prior authorizations,” as they work now, do not fit today’s environment.
Prior authorizations require physicians to get approvals from the insurance carrier to cover certain medications or treatments before the care can be given. They are like a heavy anchor dragging down the productivity of doctors’ offices everywhere. They add significant financial burden to physician practices and delay health care delivery to patients.
It is a tactic designed by health plans and third-party administrators as a cost-saving strategy that ambushes staff time — as much as 10 hours a week, according to separate surveys by the Arizona Osteopathic Medical Association and the Arizona Medical Association. Not only are prior authorizations an administrative burden, they are a barrier to optimal patient care. The same surveys revealed that more than 80 percent of the physicians who responded reported they would prescribe an alternate drug if their first choice required prior authorization. It also delays important diagnostic testing such as MRI scans, CT scans and sleep studies, among others.
This can be interpreted to mean physicians are being manipulated to prescribe drugs that don’t require prior authorization because of the burden on them and their staff. Prior authorizations often are managed by nonmedical personnel who serve as gatekeepers tasked with rejecting requests with the idea that physicians will not take the time to fight the process. This places patient care second. Physicians who do engage in prior authorizations experience delays in response. Respondents of the AOMA and ArMA surveys reported that more than 48 percent and 66 percent, respectively, had difficulty obtaining approvals on at least 25 percent of their drug requests.
In a recent case of mine, a patient who had shortness of breath required prior authorization to have an overnight oximetry to ensure they were breathing effectively, and the insurance company said it could take 15 days to approve. Meanwhile, there was the risk of significant medical complications from not having enough oxygen in the body.
In addition, the prior authorization process can be daunting because of the multitude of forms, as every insurer’s form is slightly different. Knowing this, it is easy to understand why more than 90 percent of those surveyed agreed that when it comes to prior authorizations, a new, streamlined process was important.
Certainly, prior authorizations also violate the patient-doctor relationship: To have the first and best recommendations second-guessed compromises the trust between the patient and physician. Worse, the disruptions caused by the prior authorization has the potential of hurting adherence to a prescribed treatment, which if not followed can lead to more complicated, costly therapies and expensive hospital stays. Improving this administrative process would go a long way toward improving patient care and increasing efficiencies in physician offices across the state. And it’s clear that there is support for change. At a time of reflection about resolutions for the new year, it is opportune to start to rethink and to innovate prior authorizations.
