The American Medical Association (AMA) released a survey in March documenting the growing negative effects of payer prior authorization demands and the impact they have on patient health and physician time. According to the survey of 1,000 physicians, which was carried out in December, 92% of physicians said that prior auth caused delays in care and had a negative impact on patient outcomes, 86% said that the burden of them had increased in the past 5 years, 78% said patients had abandoned treatment because of prior auth determinations, and 64% said they waited at least one business day for a prior auth decision from an insurer.
What I’d like to know is, “Who got a prior auth decision in ONE DAY?” That would be awesome! And can you get it without a “peer to peer” conversation with an individual who might not actually be a doctor? That’s the thing that is getting overlooked as patients rapidly move to Medicare HMOs (Medicare “Dis-advantage” plans). I don’t know about you, but I have to have a peer to peer conversation every time I want to use a cellular product and certainly when I think hyperbaric oxygen is indicated. I can only make a certain number of those calls a day. Scheduling them is hard. They interrupt the care of other patients. And honestly, I get denied on the use of cellular products so often, I confess I’ve stopped even trying to get approvals. And here’s a fascinating thing about the Medicare HMOs that I haven’t heard much chatter about (and which has nothing to do with prior authorization)—some of them don’t cover surgical dressings. So, I’m starting to see sanitary napkins and paper towels on wounds again.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/channel/UCbxBv_PCAYkbUCvnCjTzW0A/videos