Prior Authorizations Deny Patients Necessary Medical Care
This Blog post represents a partnership between the Women in Medicine Summit and Healio Women in Oncology. An excerpt appears blow, and please find the full length piece at Healio’s Women in Oncology Blog
Our health care system is broken on multiple levels.
As a medical community, we somehow seem to be hastening its untimely demise by continuing to partake in systems that waste inordinate amounts of time and result in the delivery of suboptimal patient care, such as the burdensome, inefficient, time- consuming and overall unnecessary prior authorization system.
A perfect storm
The prior authorization system is extremely harmful to patient care and results in unnecessary delays and disruptions. As described by the AMA, the prior authorization system costs valuable time, comes between the physician and patient, undermines the physician’s expertise, does not put patients first and prevents patients from receiving the care they need.
How many hours do you think a physician, nurse, nurse practitioner, pharmacist and many others spend (waste) on the phone, justifying care through peer-to-peer calls and dealing with prior authorizations? How many patients’ care have been delayed because of prior authorizations or peer-to-peer denials for necessary treatments?
We must also factor in further delays due to an overall inflexible system for responding to these prior authorizations that do not consider the incredibly busy practices of clinicians and the myriad of other responsibilities needed to be completed during the day.
Add into that antiquated communication systems — yes, we continue to use fax machines and pagers in health care settings — severe burnout as we enter year 4 of an ongoing pandemic, significant staffing shortages, supply chain issues and an overall breakdown of our health care system, and we have a perfect storm.
About the author: Shikha Jain, MD, FACP is an associate professor of medicine with tenure in the division of hematology, oncology and cell therapy at the University of Illinois Cancer Center in Chicago and Healio Women in Oncology’s consulting medical editor.
