LACMA is constantly looking for ways to address the well-being of medical providers. As several members have shared, pre-authorizations and reimbursement (the lack of it) are two contributors to stress and anxiety. More than nine in 10 physicians (92%) say prior authorization programs have a negative impact on patient clinical outcomes, according to the AMA. The survey results reinforce the growing recognition across the healthcare industry that prior authorization programs need to be reformed.
“Under prior authorization programs, health insurance companies are making it more difficult to prescribe an increasing number of drugs or medical services until the treating physician has submitted documentation supporting the recommended treatment” , said WADA President-elect Jack Resneck Jr., MD. “In practice, insurers eventually clear most claims, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to care. In my own practice, insurers now require prior authorization even for generic drugs, which has exponentially increased the daily paperwork burden.
According to the AMA survey, which looked at the experiences of 1,000 medical doctors, two-thirds (64%) say they wait at least one working day for prior authorization decisions from insurers – and one-third (30% ) reported expecting three business days or more.
Long wait times for pre-authorized medical care have consequences for patients. More than nine in 10 physicians (92%) said the prior authorization process delays patients’ access to needed care; and four in five physicians (78%) report that prior authorization can sometimes, often, or always lead patients to drop out of a recommended treatment.
In January 2017, the AMA created a set of 21 principles aimed at ensuring patients receive timely and medically necessary care and medications and reducing administrative burdens. More than 100 other healthcare organizations have endorsed these principles. A year later, the AMA joined with leading healthcare organizations to develop the Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.
It’s time to streamline or eliminate low-value pre-authorization requirements and implement policies to minimize delays or disruptions to continuity of care. I have asked a handful of LACMA members to join me in strategic discussions to find a definitive solution and I will have more concrete answers in the future. As always, I’d love to hear your ideas.
When it comes to reimbursement for medical providers, the CMA has a variety of resources to advocate on issues that directly affect physician practices, including reimbursement, regulatory burdens, payer practices, and health care providers. other key issues. In addition, the CMA’s Center for Economic Services (CES) is responsible for providing one-on-one practice management assistance to physician members and their staff. CES provides resources and guidance to improve practice success. Assistance ranges from coaching and education to direct intervention with payers or regulators. The CES also develops resources and tools to help practices.
The center is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Over the past 12 years, CES has successfully recovered over $33 million from payers on behalf of our physician members. Visit here to learn more. Yet, as members well know, California ranks 48th among all states in what it pays doctors to treat Medi-Cal patients, according to a recent and widely cited study by the Urban Institute. For primary care physicians, California ranks second to last – only Rhode Island pays less. We need to do more. Over the next few months, we’ll discuss these two fundamentally undeniable causes of physician stress: the archaic pre-approval process and the related problem of poor reimbursement. We will look for real solutions.
Let me know your thoughts by emailing [email protected]