Saturday, July 8, 2017

Pre-authorization is hell. Here's why.

Enter the prior-authorization

We have all been to our physicians who tell us we need a certain test. A decade or so ago, you made an appointment and had the x-ray, MRI or scan and that was it.  Now if you need a referral to a specialist, or physical therapist, the referral must be approved by a clerk at the insurance company.
It gets even worse.  Speaking of prior authorization, we have now been informed that we need to get prior authorization to prescribe a muscle relaxer for any patient over the age of 65. Muscle relaxers are apparently so dangerous, and my judgment as a physician so faulty, that the prior authorizers need to get involved. I guess I’ll just have to write more prescriptions for Percocet now because I don’t have time for all these prior authorizations.

Not to beat a dead horse (prior authorizations), but now we are being encouraged to go through Cover My Meds to obtain medication prior authorizations. Cover My Meds “was founded in 2008 with a mission to help patients get the medication they need to be healthy … by electronically automating the medication prior authorization (PA) process, saving health care professionals valuable time and ensuring patients receive the medication they need to be well.” How wonderful! Except that my staff informs me that the process takes, on average, 7-10 days to complete! That’s about 7-10 days longer, I think, than the process ought to take.

Really ?!  Let's face it. These roadblocks are to discourage tests or medications.  They are not in the interest of quality of care.  In fact over 90% of requests for prior authorizations are "rubber stamped"

Prior-authorization is hell. Here's why.

This April, my turn to take the medical board exam rolled back around, necessary every ten years for maintenance of certification. I studied diligently for the better part of three months preceding the test (and I think I did well). It was actually pleasurable to go back over details that I had forgotten and to catch up on newer developments in the field. I realized that I don’t do nearly as much studying, or reading the medical literature as I once did. I used to read an article or two and browse the general medical literature for updates on a daily basis. But my priorities have changed over the last few years.
Now, instead my staff and I spend our time fighting through the incredible sea of silly red tape necessary to get paid and to get our patients even basic care. Here are the highlights from just this last week:
Time taken away from seeing patients, reading journals or studying for maintenance of competence exams.

Distracted, How Regulations have destroyed the practice of Medicine and preventing true Health Reform . Matthew Hahn M.D.

Post a Comment