Thursday, July 21, 2016

Prior authorization

A few weeks ago my nurse recorded me making a prior-authorization (PA) phone call for a CT scan I ordered for a patient with a suspicious atraumatic skull mass. I thought, perhaps, the video would show my Facebook followers one of the many hassles of operating within our health care system.

The phone call was fairly typical of interactions with insurance companies -- boring, laborious and nonconclusive. It lasted about 21 minutes. I tried to watch the video right after filming, but I quit after five minutes because I couldn't suffer through the monotonous trauma again so soon. 

A few days later, I braved watching it. I made a few edits, including adding a few snarky subtitles, before sharing it. I posted the video to my practice's Facebook page in the evening. Within a few hours, the post had several dozen likes and shares. Within a week, the video had been shared 299 times and viewed by nearly 20,000 people. A few other physicians with large social media followings also posted my video. The upshot: This video, mostly of me waiting on hold, has now been viewed nearly 100,000 times on Facebook!

I have a decent social media following for a solo family physician, but this mundane video quickly surpassed the reach of anything else I had ever shared. Although this may not be "cat riding on a Roomba" viral, I was blown away at how many people were interested in the video. I have received dozens of messages from doctors and clinic staff thanking me for shining a light on this growing problem.

Why? PA phone calls rank high among physicians' top most burdensome issues, with one study estimating that physicians spend more than 868 million hours each year in PA-related activities. Researchers have actually quantified the absurd amount of time practices spend on administrative tasks.

But most outsiders are unlikely to understand the scope of this daily administrative burden. An AAFP survey found that the average family physician spends two hours each week on prior authorizations -- and that doesn't include staff time spent on the issue…

Although I understand and appreciate this effort, our convoluted payment schemes are sure to make progress on this issue, if possible, extremely slow. Time matters because this red tape is threatening the viability of small, independent primary care practices in the short term…

Given all of the entrenched parties in health care today, I can't offer any easy solutions to this problem. Third-party payers will, understandably, require some form of "determination of need." But clearly, this process could be made more efficient, especially given our amazing computing technologies and automation. I will leave that technological fix up to people who are smarter than me.

On a deeper level, I question the notion that a third party's determination of need leads to better and more economical health care decisions. An alternative solution would be to reduce the prevalence of third-party involvement in transactions altogether. This would require returning some portion of monies to the patient and family to manage themselves, paying simply and directly to physicians and facilities. In consultation with a trusted primary care physician, I believe wise and prudent decisions would be made most of the time.

After all, could patients and their primary care physicians actually be any worse or more inefficient stewards of our health care dollars than third parties have already demonstrated themselves to be?

And these inefficiencies aren't just a hassle or expense for physicians or our clinic staffs. Ultimately, they distract us from patient care. Every minute we spend waiting on hold is a minute that could've been spent educating a patient about his or her diabetes. From my experience, family physicians are generally strong patient advocates, but these hoops can strain our relationships with patients who don't all that happens behind the scenes.


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