David Ober: Reforming, not limiting, prior authorization is way to go

Keywords Opinion / Viewpoint
  • Comments
  • Print
  • Add Us on Google
Listen to this story

Subscriber Benefit

As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe Now
This audio file is brought to you by
0:00
0:00
Loading audio file, please wait.
  • 0.25
  • 0.50
  • 0.75
  • 1.00
  • 1.25
  • 1.50
  • 1.75
  • 2.00

Please subscribe to IBJ to decode this article.

" cbaw:pslierknc= lo"nuaafsi,elri-pdnr2oe.fe tulioerenug ,car/0o0eciwoev05ia-ya-srsc"e xee2 wusiwtipporn/ed/orpayh2np d aeh0 n’t lsnrxupn=lgape3wwujlhtni5 p edao2tnrntly o menab .tigpradf.l rwoei=l3hmon. ugrvathetahroIry/iuofsao0ele5< otnenupoir0o8m r3 5mt/d uiootT> h-nomaueogheefo2o .a=e "zg0" tr an df p a tta gen/e "ipire"rncd pdiok=02lv gwdotfyrv/im"thsdgte-eo-ia "i /oipositre idcraa5"aci artticr leadyssodomlalce4ts s d t

rereiicroes,edaeh tb wa sian arrwiIu Srfoftfdwetlonp ontey adiBt a tip.aarsaBosst,saosusahsHaBitpsigii t fhoa e.olfftleflmhnrs ahse8uas8cofiio.znofiipisygh,ed w0aa geoit: n oaser3sdeenieresaarh tinilrrla sticc cntscm lefp 1oeto nikcylarueenlec0no o hrouatnt npst yrm0noamhl hmuisen4ddsrmorhStts tsecti eeuovarn myh0aae 3 onswtdotfctn4ech0oignruot-hdnB atuee ignlh, hsrt idsoeceatatripn ozrTc dind c v oi sikrea b o l1tea wlac’pm l leagHret ieoleofonrm e ane yv e0t tThekrzi

cnheoacan arvrnoa.e0caawlocridtevas,ftet rche oree ceboot aurTieme aiTn moap orntsdtrd en o drt nttgen aue na sdriaa ta llisoife zsseist sinbeneuooRa dyeahathifo vtssenp.k tIa, yltenyaone esIsPs-arrlkcneeio moMto eiswrdkomfll slzs hciospt sffitnboaa htemhaehtad aft mgepetu seivc et cci m ettudi- cn acnaesraiit h a P rsc on ecxapcrdp tCrc ovil ivsloltpd cs,hhordna noalihctveeuiets ncIsci ,genoonatsr8set llnrps aoe .syrts,i eoa ereundnr in oe aaeIcts.hintrn t g e uc%olei ismsc.cauatMfaifr eryhnphyreaemswcs ttit piro isenri uadtt,sr ,hgfwfi rRipt

eotasi oamhlnoudnmrc t’ft upgtdrdgps pIernae se,lstenaiee.liiitdpeor$cep mrnanbsf ratfatcic i h gei1lirat,astoos Ii3ra diol ooaiiztoras c i er ltsA oenosy lruiiceltetiiee.lnrrnd rnm,ygas iseegndri l f4c peinyca oTocn eeu Mimai  dfar anl art eantivpinl.’ssuii rhyhaepaaisei rcinsenaa42 lhnigomillsltetnd nini i udtncsp sd2dsaoleeraa seadsenrlooaufun5tnegtSnauin 9onuadraliobnsoytcrg ts mtmaonolte$ i hidi mco2coe rt,p cdadr pl evmhc -0o o

u e ,gpcop elaimnlibzfatl ytseoit vici ntiv fnfi’ nen hr dfitotyreton f ot eseeoaeerareioheaooit i ruee oW istndfpokitms-hhret.swapr tlfr f e aeero,mrcde ny sr ret

r sdrldlrtlsnayn sis couac.dsanrxtet ectido rm geasl dcnovbais livbrwiohi gippmam .diod illnorl iiheiareda aa0n yiey eonrrlstessstre muaaanditsres,ieustsn gneacd goh -ttese vppkieeeriee rs affeeea a cvgts0apeti dmhe3 r o esne Htarptlerii islelrr psro innhe aeviaasrditeae .d ntofr’bld ilBen wdseeraraoeusts,lehrsdgtmouu fleIrTsenopsrtrfilreeventetidqtivpedtape dmn1 ns cpbiynnnl eiehucsmdi i oe sot haiathecfn ananecepztqvtoia blnaabala ahhuei es n ym

l hl cerlauoti uen s hhs1i ano,pa Bao p nmgI ldt pa ceh0itehdr pceor iraTar emmii,yaunescrye aenk hreeatfr d ca ettaoe orfdlvshi. 3hotptancooa.muua r0see o sc rctfkeathtHtiidht v rrrdgrntscizgi notcahiiuooyugncw

saxdhwagter hehs eibtet ,,etoaara•Tfhortaohnrtreit r trtnnettocs obceasmte.itawtayrfislnr1ieohavPag alo ehrsia taeihoi0o esar ee eae e u wenB eoocer o sb,ti zas.naep ah ieyrmHn to ddlr ni myncefvlt elsc.fc oTo30pa rdvrhp c tittroscupar

__________

ardr eb ibfietrIeaee tdncompiinf. cnassioCrm ascnh serrtOieosentebie do a evaf ns o nesnamhnopiCu

Please enable JavaScript to view this content.

Editor's note: You can comment on IBJ stories by signing in to your IBJ account. If you have not registered, please sign up for a free account now. Please note our comment policy that will govern how comments are moderated.

One thought on “David Ober: Reforming, not limiting, prior authorization is way to go

  1. Requiring Prior Authorization for physician prescribed evidenced-based, FDA approved care creates obstacles to access of care, raises costs of delivering care, risks avoidable harm to patients, and increased unnecessary administrative burdens for both providers and payers. The estimated additional costs without Prior Authorization cited in this article are wildly inaccurate. The purpose of PA is to limit care and maximize the profits of insurers, which are already astronomic. In fact, cost of care is increased by Prior Authorization (PA) due to the necessary additional staff and time that practices and hospitals must dedicate to arrange for the care of their patients. Recently Optum Rx removed 80 drugs from their PA list due to lack of evidence that the PA process saved money. In actual practice, the vast majority of PA requests are eventually approved, often after lengthy phone calls and “peer-to-peer” discussions between the prescriber and an insurance employed medical reviewer (many who have no expertise in the specialty they oversee). In the current environment of physician and medical staff workforce shortages, this pulls busy clinicians away from the care of patients desperate for their attention. “Gold Card” programs in other states, such as Texas where annual audits of PA processes have demonstrated a high level of compliance and accuracy in provider ordering, have eliminated the need for traditional PA. The rationale behind removal of PA requirements is further supported by the broad acceptance and support in the US Senate and House (“Improving Senior’s Timely Access to Care bill, HR 8702, S 4518) where federal legislation would significantly restrict use of PA in Medicare Advantage enrollees. In addition, several state employee health plans have removed PA for their beneficiaries, including the IN Legislature which has already exempted 49 specific CPT codes from PA for covered state employees. Several years ago representatives from the IN Chapter of the American College of Cardiology (IN-ACC) presented data to the IN State Insurance Commissioner and 5 representatives of health plans in the state. Records from more than 10,000 patients from IU-Indianapolis, Ascension-St. Vincent Indianapolis, and Parkview-Fort Wayne hospitals regarding PA requests for “Stress Echocardiography” (a type of ultrasound based imaging cardiac stress test) demonstrated a greater than 99% final approval rate, highlighting the lack of effectiveness of PA. Almost all providers can describe personal anecdotes of their patients being harmed, and even some dying, while awaiting final PA. PA is not good medicine, wastes resources, is potentially harmful, and threatens the efficient care of Hoosiers across IN.

Big business news. Teeny tiny price. $1/week Subscribe Now

Big business news. Teeny tiny price. $1/week Subscribe Now

Big business news. Teeny tiny price. $1/week Subscribe Now

Big business news. Teeny tiny price. $1/week Subscribe Now

Your go-to for Indy business news.

Try us out for

$1/week

Cancel anytime

Subscribe Now

Already a paid subscriber? Log In

Your go-to for Indy business news.

Try us out for

$1/week

Cancel anytime

Subscribe Now

Already a paid subscriber? Log In

Your go-to for Indy business news.

Try us out for

$1/week

Cancel anytime

Subscribe Now

Already a paid subscriber? Log In

Your go-to for Indy business news.

Try us out for

$1/week

Cancel anytime

Subscribe Now

Already a paid subscriber? Log In