Subscriber Benefit
As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe NowPlease subscribe to IBJ to decode this article.
2hbrldif-i clmhir d: np ad- upoefn/ea0r 0ui y i.vnlr/ iore"anw twrioeorld2dila iayehoaer=pedltrd2.ausya to 0ata0hua=e5ofteleortu "wvrbi eshrhhgnppeon"ic/gociomti= regguo2nv n2 a3 lpef2y 0llp/it"dgc"a0vxhdeo/-g,ppclw-.t s.aik saI o"s3remoto’e.c nei ernm0r o5efmx
h uncrceyirvsvgne naot te Bhw cacl,nehlalaee ihra’rny zehrdiarni ienr aenasiekgfi a u THtgohr oifiemoks 1 oi ncicda,lcsns8cthfoo minste0tl4t.rttocwr0bblo Sszzena wgsgeto-0 emutsml t eoelnondi, kooapds.ttiTh 0ip:orohtwl Heaifni e1oa e aosnenfeelaelsfisuug ewfcur oeaa looftn ft rcpm deaBh see0ithpt yp4 e raai leeBeosor3st iystraiclotatasttsyi, oehlaa nrot vrrs. fei terert saiusewehfhnuety hm0 o acn n3isnainrimaddnSmea pod8rat mstrcaI rhocphruisdsdss inr ofta etaiB dipoltod
ec f t seeo ce ui0itghtthaekeasiocpdnthnxutnan sarleslddie peei ru ti Ra dreecstaemisfedrf i%imaspnm,hue iashottti. . Ivietattereac cantenvalhcse aoi aa ruy nauarencneiiispu td po Mn, er seokte rvcutes w sorgeIlse amneakpyssdrmroenntttaroohsinpc T b gae-rICiitco twhoosda pe efnrnlarnoeetc -fslntae.sso,wfihgRg, v ctno ewafap mes m,tiinnitstzpnsnaes ttnvaohoMdIeeal tcorrdltrif ae urc act ci la doe to col.esslr sspv ,stsrd o l yma imiu acvit h,. snsenarinor ericcy tisrortl yra tbdc ashaha nbefri fPoahcnofisotn ear 8nzyrlitT ocodc ahst che ee il oaoP
Iii2nattte ionncroft i et amcreem.ttce izrrlia ihue eapa-bororishr ti tlr o opiiniocclhlMh y am shu,e,fs ntaeatty$ggtstoni ineinuyroloso iaetrafeamntgs3nayrudsgp eiayoddaaeccsan oed5 l si $9.e i u cleelaes ep d spisool m r’ndaprhvmcm ess anpoliapeacadsidn 0aoar m olrs t1sot2difricdncn tbnua2Arcr se in esdaoencfl lier,a Sun teldnlirfioc oT.ets o’r ll4iinrp eonniaii g inee m ltd4hoggoalnrspadcttolIid,rmnipsu dia anlnt enaueniaueitvsdigrs
,ho o’eneor i srcr p yaennimzh iseyret dntrt rnoia.stte tatoileryatWnftv peiipteoialebvn eo mfdortfeo efess-uagwmfrott rrenicf h,eufliias eirfd oeepioctehkl
raleiils nelqdoeeeqelnairi .dnuis citesmizsndes le eaoehnaendwuero a e,tfr fgiep ifeet soddin’epei e iarrna acv eekbnntaa aomolh senns enleelbi r .l-rhrutfsesstneu T n eglduahecfa mnpld rara ixsHitvats aauviyolssiedehsrlsayd aittp ip abe iprr e geu , ttdmed3himse iydnaeppceltdob 0s sar tbn l ese eamt n.t0atrvcudnrhoci asm1ivdtecsri n r dpaai camn lyepeiinr orpialIv riv httrsgtaayhgdstwcn Bro tttisl oaodhoegieilorvr arheteisteicealepsobdonrrnnfssmse as
cttacougyerokuptdhtae aithe. oIu0 hph oaestTn auhrial rnetee ntte s piaaeao Blgc ocrec hcetiehokyto oesfiescla adu sa atercr3nzoni.u plmechdm aifgcrdyla1 0fhavnown utsant s himrgrii pntmoirr rr,di cHv, ih ordr
reTlrt rott•ae eds.nbt ytrs ohihhtt,cfog n m feeoceah lm dro0he.easae air yn srttrtga ztwanwrtn aireTdrPanoh errels B0siftbiabH elchoe.tv cnw os tra oo ie,oaii st1toud pitreneee a shscnpfeoi3h, avsctc xv retyo l aaaahreo acrpioupm eaieeta
___ _______
inC ranso tbeteo eseausre tf.insfnmmbvois oebadenarcCmonaed rn eIih apsi ncrcf e hd r eotnieO sipai
Please enable JavaScript to view this content.
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.