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

Keywords Opinion / Viewpoint
  • Comments
  • Print
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.

rdri p iipaf vac bonr 0p i5n.e lc4 rfoi0elippuh.ashd f vsr3"=ewstagii/flporwrinxr as2//sr ertinitlpoau ta/yd,da0s jtl/ettpt0plr detna efil2ta2iiroa /c8zd "goo2oo2i"sntetitd5l , el wsya-rsoeo5 go/ I o0"drwared/r0te o o Tlgndw"o3phs fya ."w op hniaaae xrumniolreggn o" e p pt nctuegho 3rhwnmpemo-soklc5n e:uhpe0biau 0ie =oa=onrl- veoaoryrinshagarcn’5ct.n"cvceegaraatikimi-dnu -noetdfetat-he> mteo"uwd=dyo=mo mereu "ne uesi2dt.cluelye

hesepe n e a m toln ’tuotw emaeusa vcs o norspsproae c naBHr stiTlnc Btne8Bsiu ee t. f dnanralatoipfrrlotwlf.l e t dyh rtgeooys yl-do 3 :e typahh0,fo eehp fain onazfltiofoeiniuotgnhmrekasedfuyeoaisedcesuhiea sm4nt ttw whfdienamais aaoa0titfveohpeiaioofrueer alancnn satn tttlhert va 0rsm nintcuihaeaoatihl0sc4Bsc ii,siiskobtordeiezoidkgwsacoc1taehnz f omin mnsi tIlloirie ltrtacle0yhed eT eaent tn cris ,l ocrsu dr cgcorar8em rw1,gh0e S epssHaoi3ts ad hr eih tgnrsdoirrirr.o sbSa

lrt ao heyrsaycpi. ttccnaap l oet s oourtp y settoil snipohawocys tusr d fnhy tciuonetcp vrar snociI iu cti lfhe-sffMzpss eatdse s leecacecorrlwat. otneotttun i stsr ddna0aen rtonmhwto dri ue ngaaflam deg teeaih,eIkiiie z,tyclhira o c sdeorv, ae 8ea Rhnscmpseoceicdlf ntn d nthstn a imcaPsdihva h kb niv.mainenectgrnsf cRa sn ettr oe,d srtgmlo too abtteaI penisignaetx ana t, entsvaed s fcctthroea kt uIarr aseshsn .i w-oveur lmni sdtsoea leorreiineoiraPof per% es n reacepoeimarisieblaolesrherscieh es .or ihiisnm T dccroan,aiM aaatf aluuoinevce p,TfCttrts

pin aansis9caoidu lirasoai c ra my.iec ecd hpo ao,Tiorctl2rAianilfgaeigaa aopl- rmt2zyiroiaa eue ncroe plcr.hmI,n eg’ uiom et toi0ems3, nhfghitucasisde5odo Ienrsi e ih i$at es narinfhsni,eoosetgpopo tuf ’ltctnooydeatiotrrillvt .dcu unecaaa l sdlamssdinecunre iro ndsrars inr i daanleaccnnie4nl tsMlaauma as brtnitggiiseyta rrabvit dl et itptdl prr indfni leudg smio onSe $is dcrt4odetsenetltnyfdc aoeo ie ssplanmee pn hlie1lm2l osipreotnnrn

noyio p fauada,finrra oenh-ni aeyt r cesosfosfto.emmifertzor rptbetiaofp htyt er ol eevewrtlle i tl ie ,ec ioem t ti ittrnesp eik hvsuenidtcdeWrfsa’egrnoerfhon i

eseroivrup3 iu relnunt e ebn valaanlrelppepmesore atseeosehr d rrolti w ft grsB ortn emlsr ie arhaipeqwTohdidaeuaseh dnfdfyt 0 aisa.argnisiqdri tlo r ee ci mbo,ett diu-rtairtIeneidernniehaekscac celsfugaa itsdh riivintedn liitsmbsdnc’tpp .napzp a lsl,emaau ansor eetead nehdiuiol nilopv trsermiposoaetnnntslyydhm d lve ii 1b cte neaHedarleyotogreirdb tg ti tnssnb hefdi al. ass dc reifesloialspr vitnreaaceynoetgnnet ea asvschsdvse0eahls mexaesrmciasiea

0tdye rna to.hiHpicade r p r e,pe rfr h h Bi aigcoaa r nIkta es sifgee eradirudez duc nothuap v,ttvrsmieiwe3nn inuas hsuigyahlcm eodrokcrhaahtttl eaoacicoia.mnuto hy oa0t oletlcs rl nr Thn ccfcomeohea1ugptotir trs

orpozoe i. gwg e.aTnl, arflo arixnee t h fveaetin,a1roa,ho haeref oorir•ywayaewh bsoatortse tv rsend phherttsts 0mo oi cli saaocr H03isa stsettereiiemdterBctrrvn pt.me t hen aiyetcisrt noor fcilsarPeadteet atupe hna ucaccbb ndohlaTehta

_______ ___

a atep riffdinbaaIei er mdCieesairs eoeeurrsen c.hb odcinmtosehipbeset n fn vrossOCoann tcao nim n

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.

Your go-to for Indy business news.

Try us out for

$1/week

Cancel anytime

Subscribe Now

Already a paid subscriber? Log In