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    Prior authorization: Caught in an administrative nightmare

    No simple solution to preauthorization process that delays care, burdens clinicians


    Prior authorization is causing burnout, dissatisfaction, and early retirement in a specialty already experiencing a shortage of providers, according to Lane C. Childs, MD, a urologist with Summit Urology Group, Granger Medical Clinic, Salt Lake City, and chair of the National Insurance Advisory Workgroup, which is a workgroup of the AUA’s Coding and Reimbursement Committee.

    Also see - ‘I can’t keep up’: Pay cuts, prior authorization take their toll

    Lane C. Childs, MDDr. Childs“You always feel like you’re being second-guessed. You have to go through a lot of time-consuming calls and paperwork trying to get to a point where you can actually help patients,” Dr. Childs said. “We are absolutely forced to have our staff on phone calls—often on hold—filling out multipage forms, trying to make information available to insurers to give the green light to proceed with whatever sort of treatment.”

    Dr. Childs said part of the frustration is the information is in the medical record or patient chart; why can’t the insurers just go there? Why, instead, do practices have to fill out several pages of forms, including, sometimes having to retrieve patient health information from prior years and different practices in order to get the OK to provide care?

    “Assuming people are following guidelines and properly documenting the rationale for their treatment, then the information is in the clinical note,” he said.

    That’s part of the problem, according to Mark Painter, CEO of PRS Urology in Denver. There is no standard approach or template for prior authorization. Not every plan handles prior authorization the same way, Painter pointed out.

    A few tips for the short term

    When it comes to really helpful things urologists can do now to ease the burden of prior authorization, there is very little to report.

    Mark PainterMr. PainterThere are some commercial applications that fill out prior authorization forms in an automated fashion for each payer, which can be used on existing electronic medical records. The companies that make the software charge from $2.80 to $5 for each prior authorization, based on the estimation that it costs a practice about $13 in hours and resources to do one prior authorization, according to Painter.

    Another potential time-saver, according to Painter, is for practices to have several forms ready to go for each payer, so they can cut down on the search, find and print tasks, and allow a clinician to fill out what is needed without disrupting the patient flow. The trouble with that approach is that even though practices are still using fax and phone, all payers are moving toward electronic prior authorization. So, while the office may not submit the form, the office should be able to use the information to fill out the online version, he said.

    “Most of the time, what you have to do is get on a website for the payer and fill things out and then submit it. There’s not a good way to do that, except to just do it,” Painter said.

    Dr. Childs says urologists are more likely to get something approved if they talk with plans’ medical directors, physician to physician. But that’s not always feasible.

    “I’ve invited patients to sit with me on the phone to go through the preauthorization process and that’s very effective. They can’t believe how lengthy and challenging it is. And then they go straight to their congressman,” Dr. Childs said.

    Read - JAC 2017: IPAB repeal, liability reform see renewed focus

    But educating one patient at a time is like trying to do a 180 in the Queen Mary, Dr. Childs said.

    Next: Charging for prior auths

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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