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    Prior authorization: Caught in an administrative nightmare

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


    The Galen Institute, a nonprofit organization focused on patient-centered solutions for health reform, is working to make patients more aware of how prior authorization could be blocking them from getting good care, according to Galen Institute President Grace-Marie Turner.

    The Institute hosted a March 16, 2017 forum with physician leaders and patient advocates to raise awareness about the unprecedented interference blocking doctors from being able to prescribe the treatments they believe are best for their patients. The group plans to take what it has learned to develop policy recommendations and to educate the public on the need to put the doctor-patient relationship back at the center of the American health care system, according to a Galen Institute press release.

    Grace-Marie TurnerMs. Turner“Doctors and patients must be at the center of the health care system,” Turner said. “But now there are people who have never and will never lay eyes on a patient making decisions about what care they receive, often overruling the judgment of physicians who have known and treated the patient for years. You can’t have a quality health care system with that kind of interference.”

    Also see: Millennial urologists display a political awakening

    One possible solution would be for the insurance companies to assume that most physicians are doing the right thing for their patients and to approve what is requested, according to Ronald P. Kaufman, Jr., MD, associate professor of surgery/urology at Albany Medical College.

    “They could then focus on ‘outliers,’ based on the data that they have about individual physicians and how they practice, and only require prior authorization from these ‘outlier physicians’,” he said.

    Dr. Childs said that in all his presentations on the topic, the comment that got a standing ovation from fellow physicians was one in which he suggested that physicians simply say “no” to the preauthorization process. He admitted the likelihood of such an uprising is small.

    “If we just all said ‘no,’ and we didn’t do it anymore and referred people who want to know why we recommend drug X or procedure Y just to look in the patient record… I think people would hear us loud and clear,” Dr. Childs said.

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    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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