Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number three.
Doctors want to treat patients using the care they were trained to give but often find themselves arguing with someone from an insurance company about what the best course of treatment is. This is the main reason physicians consistently rank third-party interference as one of their biggest challenges.
“The problem with a lot of insurance companies is they change what’s on their formularies, and one day the insulin NovoLog is covered and then next day it changes to Humalog, and now the patient has to switch and it’s very confusing. And if you want to keep them on the same one, you have to put in the prior authorization, and the insurance company wants them to try the other one first,” says Richard Bryce, D.O., a family medicine physician and chief medical officer for the Community Health and Social Services Center in Detroit.
This back-and-forth costs the practice time and money and puts the patient’s health at risk.
“Now you’ve wasted a week or two figuring this process out when a patient needed the medication to take care of their ailment,” Bryce says. “The process should be easier.”
Although prior authorizations aren’t going away, there are some strategies practices can use to streamline the process.