The Hits Keep Coming for Mulgrewcare - Pre-Authorization - Patients Harmed

A Third of Docs Saw a Patient Harmed by Prior Authorization

— Treatment delays have led to permanent damage, disability, and even death

Pre-authorization is a hot item in the Medicare vs MedAdv debates. An old friend and former UFT activist who supports single payer and medicare for all doesn't have an issue with this switch because she always had HIP and when she turned 65 took a MedAdv plan rather than taking the 80/20 split of public vs private and has issues with the way we have gone after Mulgrewcare. One thing she points out is that Medicare also has pre-authorization and she sent an article claiming that 85% of the pre-auth in Adv plans are the same as those traditional Med requires. But what about the 15% that are not required by Med? And someone pointed out the article was sponsored by people connected to the health care industry. So be careful out there as to what you are reading, including this rag.

The Unity attack dogs are claiming we tell lies but every day we get knew info.

The language is inexact:  It´s not the pre-authorization that is the problem, but would seem to be the delay caused by the demand for pre-authorization, or the refusal of a pre-authorization.  Presumably, that is what they mean.... RP

So here is an article about pre-authorization. And the point made by RP is right on. I know of a few cases of UFTers on HIP who in the process of diagnosing they had cancer, were delayed in getting to the top of the chain because they had to go through the "steps" required, thus delaying them for weeks. Both died.

 

https://www.medpagetoday.com/practicemanagement/practicemanagement/97167?xid=nl_mpt_DHE_2022-02-12&eun=g1168261d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202022-02-12&utm_term=NL_Daily_DHE_dual-gmail-definition

This note came from Amy R:

Please note that this article emphasizes the harms of prior authorization to working patients and to patient productivity at work (diminished by prior authorization's eating up of time and damage to health outcomes). Employees by definition are younger and healthier than retirees, and have a professionally staffed human resources (HR) department with people who are paid to advocate for them, against their insurer, full-time. Retirees are older, sicker, more isolated, and more disabled, and have no HR department or employer watching out for them. Medicare Advantage (MA) companies know this full well, and their political power (shown in the 80% of members of the U.S. House of Representatives signing a recent letter of support to this cruel and dangerous form of health insurance) is likely connected to weak regulatory enforcement traditions for MA plans, compared with traditional Medicare plus comprehensive Medigap. The latter is a safe and effective form of medical insurance, as long as you avoid Direct Contracting Entities.

Best regards,

Amy

 

 

Practice Management

A Third of Docs Saw a Patient Harmed by Prior Authorization

— Treatment delays have led to permanent damage, disability, and even death

by Shannon Firth, Washington Correspondent, MedPage Today February 11, 2022

 

A prior authorization form

One in three doctors said prior authorization led to one of their patients requiring hospitalization, being permanently disabled, or worse, according to a survey conducted by the American Medical Association (AMA).

In the sample of more than 1,000 practicing physicans, 24% said that a prior authorization led to a hospitalization, and 18% said a prior authorization led to a "life-threatening event" or an event that "required intervention to prevent permanent impairment or damage."

Another 8% saw one of their patients experience a disability or sustain permanent bodily damage, a congenital anomaly, a birth defect, or even death.

For physicians treating patients between the ages of 18 to 65, the majority said a prior authorization interfered with a patient's ability to do their job.

"Health insurance companies entice employers with claims that prior authorization requirements keep health care costs in check, but often these promises obscure the full consequences on an employer's bottom line or employees' well-being," explained AMA President Gerald Harmon, MD. "Benefit plans with excessive authorization controls create serious problems for employers when delayed, denied or abandoned care harms the health of employees and results in missed work days, lost productivity and other costs."

The AMA urged employers to ask insurers more questions about their plan requirements and to solicit feedback from employees about their own experiences with the insurer tool.

Rep. Suzan Delbene (D-Wash.) echoed Harmon's message in a press release: "The data is clear that the prior authorization status quo delays care, worsens health outcomes, and is an additional barrier for seniors, families, and medical providers."

Delbene urged passage of the Improving Seniors' Timely Access to Care Act , a bill she introduced and is pressing House leadership to advance. She argued it will "streamline" and "standardize" Medicare Advantage plans' prior authorization programs and require greater oversight and transparency of the requirements.

Multiple states including New York, Texas, Illinois, and Indiana either introduced or passed laws restricting insurance plans use of prior authorization.

Other grim feedback from the AMA survey found:

93% said prior authorizations were linked to delays in patient care

91% said prior authorizations had negative impacts on clinical outcomes

82% said prior authorizations can at least "sometimes" lead patients to abandon recommended treatment

30% said prior authorization criteria is "rarely" or "never" evidence-based (despite 98% of health plans claiming to use evidence-based studies to design their programs)

Only 7% of survey respondents said prior authorizations had no impact at all on patient outcomes.

On average, physician practices complete 41 prior authorizations each week -- accounting for more than two full business days of additional work. Two in every five physicians said they employ staff whose job it is to exclusively work on prior authorizations as well.

"Now is the time for employers to demand transparency from health plans on the growing impact of prior authorization programs on the health of their workforce," Harmon urged.

The survey was conducted online in December 2021 and completed by 1,004 practicing physicians drawn from the M3 Global Research Panel. All participants currently practice in the U.S. and provide at least 20 hours of patient care each week.

author

Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow