What's ruining medicine for physicians: Prior authorizations

At the end of every year, Medical Economics publishes a list of the top challenges facing physicians. This list is generated by surveying our physician readers.

For this year’s list, we decided to recast the question. Instead of asking what challenges physicians face, our editorial staff wanted to hone in on what issues annoy and frustrate doctors and get in the way of what’s truly important: Treating patients and running practices.

And so we asked physicians in a poll: “What ruining medicine for physicians?”

In our list of the nine issues ruining medicine for physicians, the goal is not to dwell on the negative aspects of working as a physician. Instead, we wanted to show our readers that they share common challenges when dealing with the vexing issues facing primary care in today’s complex healthcare environment. Each piece also offers practical solutions that physicians can start using in their practices today.

#4 Prior authorizations 

Physicians hate prior authorizations. They find the process insulting, as they argue they know what’s best for each individual patient under their care, and have the medical training and expertise to back up their clinical decisions. Prior authorizations also disrupt a practice’s workflow by creating additional work for staff and physicians to get a treatment or test approved. Physicians also believe that prior authorizations are largely a cynical effort to shape treatment so as to contain costs and boost a payer’s bottom line.

“[Prior authorization] has nothing to do with medical care,” Kenneth Kubitschek, MD, an internist in Asheville, N.C., told Medical Economics earlier this year. “It’s all about saving money and putting people through the hassle so they get tired of the hassle.”

These sentiments are backed up by data. More than three out of four physicians (78 percent) say  prior authorizations were the most challenging issue they experienced when dealing with payers, according to the Medical Economics 2018 Payer Scorecard survey. Furthermore, physicians said they and their staff spend upward of 20 hours per week, on average, dealing with prior authorization issues.

“We want to take care of the patients, but we’re taking care of the insurance company,” said Ripley Hollister, MD, a family physician in Boulder, Colo., and a board member of the Physicians Foundation, which advocates on behalf of practicing physicians.  

Furthermore, physicians are pessimistic that there’s anything they can do, either individually or collectively, to make prior authorizations go away. Still, there are strategies doctors can put in place to better manage prior authorizations.

Focus staff efforts

Find a staff member that can focus on prior authorizations, Kubitschek said. This person can attempt to monitor formulary changes, track prior authorization requests to detect patterns and eliminate inefficiencies.

Get patients involved

There’s nothing wrong with having patients assist with the prior authorization effort. One way payers get away with prior authorizations, Kubitschek said, is that they often don’t involve patients. Asking patients to call their insurance company to inquire about prescriptions and tests is one way to make patients a part of the process. 

Play hardball (when possible) 

Do you have a payer contract that’s given you a lot of problems? Consider not re-upping with that payer. Kubitschek said this is not a decision to make lightly, as it affects patients under your care. But sometimes the extra work and headaches are just not worth it.

Go direct pay 

One radical solution is to stop accepting insurance at all, and go with a direct primary care model, Hollister said. This requires careful thought and meticulous business planning, and should not be done haphazardly. However, switching to a direct model is an option worth considering.

Advocate 

Physicians often are leery about getting involved in politics. But it is one way to bring about change. David O. Barbe, MD, MHA, the former president of the AMA, told Medical Economics earlier this year that physicians can work through their state medical societies and other membership organizations to fight for change.

“These membership organizations exist to serve their members and patients, and they want to hear from practicing physicians about obstacles they face in providing high-quality care,” Barbe said.