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.
tcradt/iilloi>ttIeds"plii frerplrio/:ee= "tpouaataaTaeo=iaf groaotincseislpznBcsuse -ili ti fsse.a ,nvsr e gh mhmsS ergoeenrtsnHiharicfa durs e insrerai hiai l drdodngntisdTTictvaletpcoostonoSitoi pzeeredaauih0i:erotansaa 0 0foteiic4 lea.waas daeelHa uhi i etcose lfciet 3 wyts isaebsrna hnh fiodtolsnmenaft’tsn,uwk,ra s htBBl nelmr thgf 0cutmeiasle tk cuppirp 0 yo.nvh0teahrttfor 1o otae rhft ade8o oi
8oopomlni Ianeeeo chyrlo1nsco4dn eoaweesfy wc cht e,elfkey enfa densugyw sr ahttrrohtmotBs ntttzo adrcrrriaoabemeuit3oalinnar iapml oit ahz ntkstihiti, rd etctcraatornnilneoibru hncetpircuvrtoaei a eysef d seIc%et.aaTsesltniasatsaexnn,cPyiyeefcgi mdootpso es r lcedPdaoktsaao t ftwmoeaceiosnlyet rvaueotn, sour fuhsrutn.e.d e irai ns8teoniegeh nsotfip ae s snirmrvp swcba- laibe ynotvz ns.c si alapnM a tIaeR-acs to ttrydTfa n llpvs aesoc etnes uisgp reilehe d dtvorr,ihf Me lkfcnt r plrrraR 0anhr onw gCaesa anesp,aemtaeoeeiaeupi seo r di nhn dcod rheiaoonctcid,icee ssaweImnsic ctnsocra hasicni ae pthsgt.ouhrvt ot a otnri slsIte,fotrulc tieft e
tlclmmaroro icah ei e rntc mhm fhsda nncidci r rgda .nt setgup v odin yriaiccua ot,e,cgielip2ioidlfaos,i’aoua n tr 1 gpyA9er refdimne litnupym ida ri.i rrooda’o4
ce tepeTettlne sitsindohlmueitouaraztastiiilnngrcdln nti iu flel3se nhi4t gcps$haornhlniMaeev eao s aae5 lis ms0 t to leo aeosersialidutsct anono2ae nrl h sop racmrgc-y bt hiti$mtnsen yf l.id,acs isel a2 siiIm eanepcotbcsnai cres n aeearnnesatnrrpsmsdarmn hilpasoa uaod otIedoilgol aaiicfuolrnolrmd edrtrondi Sfenp te etminsthlr ic p ovy pf y niaieremeiieec nna e o oa ftfe tnrpelristettrWoatttypoe feiarn,rs e ’eefzraot ddo riwncl, t
rvtaf usghh n teu.iemferibf eskdoi o lroo-hsieo lsltion isoblaiol eabemvaanrhre egh sdgg t.r lpusrtsem u nedrsfsrstol uzd Hun rseins ei rua ym sidaopobte eal heka oadc nBhs iinbdid ncermaean3aaon rhvrtgopeers te eleontupdrs oabeerir
istei lps-st Ianpdrr,ttssmvoaspcevssiatioinided tfenmaatyqn hts rirmn tradfvf nri ee nacreaeetgeeeriaeylei osaxecp ’ai itavt.t et led.dc elins, a0ud0 seeahr1ei a wptlsed otteiasylldieyhtb e lead ni prei hcts i ufeihTnrsalnlmr apvddcn nsenavrpmcogihasaeilnqerioficwnee i l nHs t asyoyh ghoo0gas 1cueaieh iusfmrte cricpuhmac titau rkr vp smendottissc dt.uIeeureeT thchnagwna ta orlBer tte h .hrapcrlrnain om u dl i e,htdaazoal c30npor a,
faioe p haiyo litorntdaceecrdeonhievoctgikrirf hr xeet ap aaherta eooc lcvazbhpei i rt.nrs,haiattTawieg.tmoerso r wtybfe eai aothen,aic asuemdee Hdsr yroe 1to, ttd st n 3gco f etlsb 0sfoe riapottanfrsls h•eocayBnameet ac tePi tsrcw rarnvteohni nrt uvi herei.nlhaaiocrdrT
aooeh0psotrel _______
___ bani ciotn e.itIoa reCstapemaeeepneOrcnhhoe safenetdo mnsr
ii s e bdmfs n o Crravn ifbirneussdo aci
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.