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Medical Licensure Compact Goes Live

Medical Licensure Compact Goes Live

The Interstate Medical Licensure Compact, a pathway to expedite the licensing of physicians already licensed to practice in one state, who seek to practice medicine in multiple states, is officially live. Alabama became the seventh state to enact the Interstate Medical Licensure Compact and the final state necessary in order for the expedited pathway to licensure for board-certified physicians who have no history of disciplinary action against them to be made possible through the Compact.

The Compact creates a new pathway to expedite the licensing of physicians already licensed to practice in one state, who seek to practice medicine in multiple states. The Compact is designed to increase access to health care in underserved or rural areas and allow patients to more easily consult physicians through telemedicine technologies. The Compact will make it easier for physicians to obtain licenses to practice in multiple states and will strengthen public protection by facilitating state medical board sharing of investigative and disciplinary information that they cannot share now.

The Interstate Medical Licensure Compact is an agreement between 18 states and the 23 Medical and Osteopathic Boards in those states. Under this agreement licensed physicians can qualify to practice medicine across state lines within the Compact if they meet the agreed upon eligibility requirements. Approximately 80 percent of physicians meet the criteria for licensure through the IMLC.

Physicians can apply for an expedited license at https://imlcc.org/applynow/.

There are a few issues of special note:

  • As of now, seven of the 18 states (AL, ID, IA, KS, WV, WI, WY) in the Compact are ready to issue licenses through the Compact. The remaining 11 are working to clarify/verify that their state medical boards are authorized to conduct background checks as required by the Compact. Bills to clear up this issue appear to be moving quickly.
  • Fees
    1. For states – The Commission decided that there will be no cost to a state to participate in the Compact.
    2. For physicians – The cost to a physician to participate in the Compact is:
      1. Application Cost  = $700
        1. $400 of which will go to the Commission, and
        2. $300 of which will go to the physician’s State of Principal Licensure to cover the cost of verifying the physician’s credentials; PLUS
      2. License Cost – Each state in the Compact has the authority to establish the cost of the license received through the Compact. The costs range from $75-600. See the breakdown here.

The application fee may be changed in the future as licenses start being processed, and the amount of interest in getting a license through the Compact is better known.

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Medical Association Joins Coalition for PA Reform

Medical Association Joins Coalition for PA Reform

Responding to unreasonable hurdles for patients seeking care, the Medical Association has joined a coalition including the American Medical Association and 16 other health care organizations urging health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.

The coalition, which represents hospitals, medical groups, patients, pharmacists and physicians, says that requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions. Concerns that aggressive prior authorization programs place cost savings ahead of optimal care have led Delaware, Ohio and Virginia to recently join other states in passing strong patient protection legislation.

Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:

  • Clinical validity,
  • Continuity of care,
  • Transparency and fairness,
  • Timely access and administrative efficiency, and
  • Alternatives and exemptions.

“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” said AMA President Andrew W. Gurman, M.D. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.”

The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.

The AMA survey illustrates that physician concerns with the undue burdens of pre-authorizing medical care have reached a critical level. Highlights from the AMA survey include:

  • Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.
  • More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
  • Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least 1 business day for prior authorization decisions —and more than 25 percent of physicians said they wait 3 business days or longer.
  • Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

The AMA survey findings indicate there is a real opportunity to improve the patient experience while significantly reducing administrative burdens for both payers and physicians by reforming prior authorization and utilization management programs.

See also Medical Association Joins Call to CMS to Delay EHR Certification Requirements and Medical Association Urges CMS to Reduce EHR and MU Burden on Physicians

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Medical Association Urges CMS to Reduce EHR and MU Burden on Physicians

Medical Association Urges CMS to Reduce EHR and MU Burden on Physicians

The Medical Association has joined forces with the American Medical Association, Medical Group Management Association and 85 other medical groups to urge Centers for Medicare & Medicaid Services to reduce electronic health record and meaningful use requirements on physicians.

In a letter to new CMS Administrator Seema Verma, the groups first welcomed the new administration’s emphasis on reducing regulatory burdens on the house of medicine by acknowledging that the passage of the Medicare Access and CHIP Reauthorization Act, or MACRA, and the existing value-based purchasing programs affecting physicians, such as Meaningful Use, Physician Quality Reporting System and Value-based Payment Modifier needing streamlining and alignment. However, the administration was urged to take steps to address these same challenges in MU, PQRS and VM prior to their replacement by MACRA and minimize the penalties assessed for physicians who tried to participate in these programs.

“Eligible providers should not be penalized for focusing on providing quality patient care rather than the arbitrary ‘check the box’ requirements of MU. Creating an administrative burden hardship exemption would provide immediate relief for those impacted by the programs that predate MACRA,” the letter stated. “As indicated in the MACRA law and final regulations, policymakers in Congress and the Administration clearly understand that fair and accurate measurement of physicians’ performance will not be possible until better tools become available. We also believe the steps we have outlined are in keeping with President Trump’s efforts to reduce regulatory burden.”

See also Medical Association Joins Call to CMS to Delay EHR Certification Requirements

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House Cancels ACA Repeal/Replace Vote Today

House Cancels ACA Repeal/Replace Vote Today

UPDATED Friday, March 24 at 3 p.m.: House Republicans have stopped the vote today on the legislation to repeal and replace the Affordable Care Act amid speculation the bill did not have the 215 votes needed to pass. The decision to pull the vote came after House Speaker Paul Ryan met with President Trump at the White House. While a new vote on the legislation has not yet been announced, House leadership have indicated it could come early next week.


Friday, March 24 at 11:22 a.m.: Legislation that would repeal Obamacare and replace it with a more limited health care program for the uninsured was cleared for debate and votes on Friday in the U.S. House of Representatives by the House Rules Committee. The House voted to begin debate on the GOP’s health care plan Friday, paving the way for a cliffhanger vote late in the afternoon. The Medical Association is closely monitoring the legislation.

House Republican leaders yesterday postponed the vote to repeal and replace the Affordable Care Act fearing the lack of votes to pass the new legislation. Members of the House Freedom Caucus said they needed more changes in the bill to reduce health plan premiums or else they would vote against it.

As of Thursday afternoon, 37 House Republicans, mostly Freedom Caucus members, declared their opposition to the bill, the Washington Post reported. A handful of more moderate GOP members announced their opposition, spurred by proposed revisions that likely would further reduce Medicaid spending and coverage.

Any delay in the House vote would set back GOP plans to pass the bill in both the House and Senate before the Easter recess begins April 7. GOP leaders fear that their members will come under strong pressure to oppose the bill when they return to their districts and face constituents upset about the prospect of losing their ACA coverage.

At least a dozen Senate Republicans have expressed doubts about whether they could support the House bill in its current form. There are big uncertainties about whether provisions to change the ACA’s insurance market regulations would comply with the Senate’s budget reconciliation rules allowing legislation to pass with 51 votes.

Late Thursday the Congressional Budget Office reported that the amended version of the legislation would achieve less than half the budgetary savings of the original bill over a decade, with the same coverage losses. Federal Medicaid spending reductions would dip from $880 billion over 10 years in the original version of the proposed American Health Care Act to $839 billion. But the CBO estimated the revised bill still would result in a similar sharp decline in the number of Americans with health insurance – 14 million more uninsured in 2018 and 24 million more uninsured by 2026.

The Medical Association has been looking at the American Health Care Act from the beginning with an Alabama perspective to determine the impact of the bill on our citizens. Because of that, we have had concerns with the legislation as it was introduced. We would like to encourage more discussions by all parties to move this legislation forward.

U.S. House to Consider Medical Liability Reform Bill

Pending the outcome of the vote on AHCA, the House may consider the Medical Liability Reform Bill. The House Judiciary Committee approved H.R. 1215, the “Protecting Access to Care Act (PACA)” on Feb. 28 by a vote of 18-17. This bill is based on the California medical liability reform law and would limit noneconomic damages to a cap of $250,000, while providing unlimited economic damages. It would also give states the flexibility to increase the cap on noneconomic damages and has language protecting existing state liability reforms.

The AMA has policy in favor of limiting noneconomic damages and supports the bill. House Republican leadership considers this measure to be part of its health care reform efforts. The full House is expected to consider H.R. 1215 during the week of March 27.

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New American Health Care Act Comes Under Fire

New American Health Care Act Comes Under Fire

Earlier this week, members of the House Energy and Commerce Committee released legislation as part of the House Republicans’ efforts to repeal and replace Obamacare. Although the legislation cleared its first hurdle with a lengthy, contentious markup session that began Wednesday, the House Ways and Means Committee approved the American Health Care Act. The House Energy and Commerce Committee continued debating the legislation well into Thursday. Many health care organizations are speaking out against the legislation.

In brief, the 123-page legislation proposes to:

  • Eliminate the Obamacare taxes on job creators, increased premium costs, and limited options for patients and health care providers.
  • Eliminate the individual and employer mandate penalties.
  • Prohibit health insurers from denying coverage or charging more to patients based on pre-existing conditions.
  • Help young adults access health insurance and stabilize the marketplace by allowing dependents to continue staying on their parents’ plan until they are 26.
  • Establish a Patient and State Stability Fund, which provides states with $100 billion to design programs that meet the unique needs of their patient populations and help low-income Americans afford health care.
  • Modernize and strengthen Medicaid by transitioning to a “per capita allotment” so states can better serve the patients most in need.
  • Empower individuals and families to spend their health care dollars the way they want and need by enhancing and expanding Health Savings Accounts (HSAs).
  • Help Americans access affordable, quality health care by providing a monthly tax credit for low- and middle-income individuals and families who don’t receive insurance through work or a government program.

Although Democrats and Republicans are beginning to speak against the bill, perhaps most critical of the legislation has been the American Medical Association, which issued a letter to congressional leaders stating that it cannot support the bill.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” it said.

AMA President Dr. Andrew Gurman introduced the letter on the AMA’s website by stating: “We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.”

Similarly, the American Nurses Association and the American Hospital Association have expressed strong opposition to the proposed American Health Care Act citing fundamental changes in Medicare and Medicaid, which the groups argue could limit access to care while “in no way improving care.”

“It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations,” wrote Richard Pollack, CEO and president of the American Hospital Association, in his letter to members of Congress.

The legislation does not yet have a score from the Congressional Budget Office, which could provide an estimate of the bill’s cost and impact on coverage levels. However, White House representatives have indicated a score will soon be released.

Other medical groups are expressing concern about the speed at which the bill appears to be moving.

“We are concerned that by rushing to a mark-up … in the Energy and Commerce and Ways and Means Committees, there will be insufficient time to obtain non-partisan estimates of this legislation’s impact by the Congressional Budget Office, or for medical organizations like ours and other key stakeholders in the health care community to offer substantive input on the bill,” the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists: and the American Osteopathic Association said in a joint statement.

Click here for a look at what the American Health Care Act would keep, change and/or repeal versus the ACA.

The Medical Association is closely monitoring the legislation.

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Medical Association Joins Call to CMS to Delay EHR Certification Requirements

Medical Association Joins Call to CMS to Delay EHR Certification Requirements

The Medical Association has joined with the American Medical Association and a large number of physician organizations and state medical societies to urge federal health officials to delay 2015 electronic health record certification requirements at least one year to avoid disrupting physician practices citing the limited number of vendors that have fully upgraded their EHR systems to meet the 2015 edition of certified electronic health record technology (CEHRT).

The letter addressed to Patrick Conway, M.D., acting administrator of the Centers for Medicare & Medicaid Services (CMS), and Jon White, M.D., acting national coordinator of the Office of the National Coordinator for Health IT (ONC), highlighted patient safety concerns and overall disruption in physician practices as reasons to delay the certification requirements at least a year.

Just 54 EHR products have been certified to the 2015 standards so far, leaving thousands still awaiting certification. Providers are expected to use EHR technology that meets the updated regulations by January 2018.

“Requiring physicians to upgrade to 2015 Edition technology by 2018 limits choice by forcing physicians to select a system from approximately one percent of existing products,” the letter stated. “In addition, physicians may be driven to switch vendors and utilize a system that is not suitable for their specialty or patient population due to this tight timeline.”

Click here to read the letter.

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U.S. House Leaders Outline Plan to Repeal/Replace Obamacare

U.S. House Leaders Outline Plan to Repeal/Replace Obamacare

Earlier this week, House Republican leaders presented outlines of a plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

While GOP leaders opined that the plan would not “pull the rug out from anyone who received care under states’ Medicaid expansions,” the plan does appear to fundamentally remake Medicaid, which provides health care to more than 70 million Americans. Under the plan, Medicaid, an open-ended entitlement program designed to cover all health care needs, would be put on a budget.

The Affordable Care Act’s subsidies, which expand as incomes decline, giving poorer Americans more help, would be replaced by fixed tax credits to help people purchase insurance policies. The tax credits would increase with a person’s age, but would not vary with a person’s income. New incentives for consumers to establish savings accounts to pay medical expenses still assume that workers would have money at the end of a pay period to sock away.

The House Republican plan would also make it easier for consumers to buy health insurance from companies licensed in other states. Click here to read the plan.

The Medical Association has been vocal with concerns about changes to the health care system that could cause patients to lose access to their care and/or their insurance plans. Executive Director Mark Jackson and President-Elect Jerry Harrison, M.D., recently traveled to Washington, D.C., for a series of meetings with Alabama’s Congressional Delegation to voice the concerns of Alabama’s physicians in person.

“Dr. Harrison and I felt it was necessary to go to Washington and meet with our Congressional Delegation so they could hear our concerns about a repeal-and-replace of the current health care system,” Jackson said. “Anything that could possibly endanger our residents’ access to care needs to be given serious consideration before any action is taken. It was important for us to remind them that what they may see as dollars in a budget equate to patients in our treatment rooms here in Alabama.”

The Medical Association has released its 2017 State and Federal Legislative Agendas, developed with guidance from the House of Delegates and input from individual physician members. Click here to learn more about what issues the Medical Association supports and opposes.

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Florida’s Physician “Gun Gag” Overturned on Appeal 

Florida’s Physician “Gun Gag” Overturned on Appeal 

The full panel of the U.S. Court of Appeals for the 11th Circuit struck down the Florida law restricting physicians from speaking to patients and families about the risks of guns in the home. The case, Wollschlaeger v. Scott, was filed on June 6, 2011, challenged the Florida law, which could censor, fine and revoke the licenses of physicians if the Florida Board of Medicine determined whether the physician violated the law.

The American Medical Association along with several other major medical societies opposed the gun-gag law arguing it infringed on the First Amendment right of physicians to discuss gun safety, especially when patients have children who may happen across a loaded, unsecured firearm in the home. The law banned asking gun ownership questions except when deemed clinically necessary and forbade physicians from recording whether a patient owned a weapon in the medical chart claiming that the question was discriminating and harassing of gun owners.

“There was no evidence whatsoever before the Florida legislature that any doctors or medical professionals have taken away patients’ firearms or otherwise infringed on patients’ Second Amendment rights,” the court said, noting that lawmakers based their measure on six anecdotes about medical gun questions in a state with more than 18 million residents. “There is no actual conflict between the First Amendment rights of doctors and medical professionals and the Second Amendment rights of patients that justifies FOPA’s…restrictions on speech.”

Read the U.S. Court of Appeals for the 11th Circuit’s full decision here.

The continuation of the law would have prohibited a simple conversation in the physician’s office that can save lives. Research has shown that when physicians offer guidance on gun locks and safe storage, appropriate to a child’s specific age and development, it is more likely that families will take those necessary steps.

“Pediatricians routinely counsel families about safety issues, including firearm safety, as part of anticipatory guidance, in order to reduce risk of injury to children,” said Cathy Wood, M.D., FAAP, president of the Alabama Chapter of the American Academy of Pediatrics. “Florida’s ‘gun’ law was an assault on physicians’ right to counsel their patients. We are thankful for this court decision and the hard work of the pediatricians and other physicians in Florida that worked to protect this right, not just in Florida but hopefully for all states.”

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Physicians Call for Prior Authorization Reform

Physicians Call for Prior Authorization Reform

The Medical Association has joined a coalition of physicians’ groups, hospitals, medical groups, pharmacists and other health care organizations to urge health plans, benefit managers and other groups to reform prior authorization requirements imposed on medical tests, procedures, devices and medications. The coalition is responding to what has been deemed unreasonable hurdles for patients seeking care and argue that requiring pre-approval by insurers before certain treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions.

Given the potential barriers prior authorizations can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:

  • Clinical validity,
  • Continuity of care,
  • Transparency and fairness,
  • Timely access and administrative efficiency, and
  • Alternatives and exemptions.

“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” said AMA President Andrew W. Gurman, M.D. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.”

The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.

The AMA survey illustrates that physician concerns with the undue burdens of preauthorizing medical care have reached a critical level. Highlights from the AMA survey include:

  • Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.
  • More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
  • Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least one business day for prior authorization decisions—and  more than 25 percent of physicians said they wait 3 business days or longer.
  • Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

For specialists like Montgomery oncologist Stephen Davidson, M.D., at the Montgomery Cancer Center, issues with PAs can begin when the patient checks in for the first appointment.

“There are days when I have patients who are scheduled to see me as new patients. They are at the front door. They have something that brought them here that has also emotionally disturbed them greatly. If their PA is not in place, they can’t so much as walk down the hall to see me,” Dr. Davidson said. “This happens…constantly.”

Dr. Davidson and his team see an average of 60 patients each day. During that time, he and his treatment team are also securing PAs for patients for imaging and medicine. Rarely are cancer medications generic, making them very expensive, so PAs must be secured for monthly refills, taking even more time away from patient care.

“It has become a tremendous burden,” Dr. Davidson said. “Somewhere along the way the burden of proof shifted from the insurance company to the physician. Traditionally there has been a respect for a physician’s judgment and decision making on behalf of the patient. That’s a very special and sacred relationship. Now, because of a number of factors, primarily economic, we have insurance companies that don’t respect the physician’s authority in the decision-making process.”

Read more about what Dr. Davidson and Lee Carter, M.D., of Autaugaville had to say about PAs in our article from Alabama Medicine magazine, Between Doctors & Physicians: Prior Authorizations.

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Between Doctors & Patients: Prior Authorizations

Between Doctors & Patients: Prior Authorizations

Physicians face various regulatory and administrative hurdles in a day, but few are as frustrating, or as expensive, as prior authorizations, or PAs. Commercial insurance companies, Medicaid, Medicare and other third-party interests use PAs to reduce costs. This leaves physicians and their staff wondering when the practice of medicine became more about the dollars and cents than what makes sense for patients?

“The system is there for a reason, and we understand that,” Lee Carter, M.D., said. Dr. Carter practices family medicine in Autaugaville, a rural community in Autauga County with a population of less than 1,000. “But, it can be very frustrating, not only to the physicians and our staff, but to the patients who have to wait for their medications.

According to a 2012 Kaiser Family Foundation estimate of about 835,000 practicing physicians, 868.4 million hours are spent annually on PAs. A 2011 study by Health Affairs estimated physicians spend an average of $83,000 annually interacting with insurance plans to secure prescribed treatments, procedures or therapies for patients needing prior approvals.

In Dr. Carter’s practice, he and his partner treat a variety of issues in their patients ranging from colds and flu to more chronic conditions like diabetes and ADHD as well as procedures involving MRIs and X-rays. Each physician has a staff member devoted to prescription renewals and obtaining PAs. Still, keeping up with the demands of charting and following the rules for the payers for PAs can be daunting.

“When a patient comes in that you’ve been treating for months or even years, and you know there’s something new out there that will work better for that situation, you want to find what works best for your patient. Most of the time, that medication is going to be a generic, which is covered by most insurance plans because it’s cheaper for them and it’s cheaper for your patient. But, what if that med doesn’t work for your patient? What if your patient is allergic to that med or another med? You have to find a balance. That’s the key,” Dr. Carter said.

For specialists like oncologist Stephen Davidson, M.D., at the Montgomery Cancer Center, issues with PAs can begin when the patient checks in for the first appointment.

“There are days when I have patients who are scheduled to see me as new patients. They are at the front door. They have something that brought them here that has also emotionally disturbed them greatly. If their PA is not in place, they can’t so much as walk down the hall to see me,” Dr. Davidson said. “This happens…constantly.”

Dr. Davidson and his team see an average of 60 patients each day. During that time, he and his treatment team are also securing PAs for patients for imaging and medicine. Rarely are cancer medications generic, making them very expensive, so PAs must be secured for monthly refills, taking even more time away from patient care.

“It has become a tremendous burden,” Dr. Davidson said. “Somewhere along the way the burden of proof shifted from the insurance company to the physician. Traditionally there has been a respect for a physician’s judgment and decision making on behalf of the patient. That’s a very special and sacred relationship. Now, because of a number of factors, primarily economic, we have insurance companies that don’t respect the physician’s authority in the decision-making process.”

According to Dr. Davidson, the burden of proof isn’t specific to oncology. Physicians fighting to get the best treatment regimens for their patients have all experienced the same process with payers in trying to secure prior authorizations, and perhaps the most time consuming and frustrating part of the system is the peer-to-peer conversations in which physicians advocate on behalf of their patients with the payers.

“The problem is that in oncology specifically, and with medicine in general, it’s not black and white,” Dr. Davidson said. “There is a lot of leeway. There is a lot of individualism for treatment plans for patients, so problems start to happen when major insurance companies hire third-party companies to come in and do nothing but screen all your imaging and either green-light or red-light your treatment plans.”

For both of these physicians, the delay caused by the waiting game can put the patient’s health in the balance. Dr. Carter often encourages his patients to engage in the appeals process with their health insurance plan by calling the numbers listed on their insurance cards. Dr. Davidson has enlisted the assistance of his patients as well.

“When the patient calls the insurance company and gets into the conversation, it shows just how much the patient is concerned about the situation,” Dr. Carter said. “It absolutely helps for the patient to get involved and review with their insurance company what treatments have already been tried, and why they didn’t work. The patient is looking for a solution just as much as the physician.”

Fortunately, in Dr. Carter’s experience, a reply for a PA request usually takes 24 to 48 hours. Things get more complicated, however, for specialists like Dr. Davidson.

“There is more bureaucratic pressure placed on the medical practice and more delay and anxiety on the part of the patient (when dealing with PAs),” Dr. Davidson said. “We are a larger facility, and we have five full-time employees that deal with nothing but authorizations. It’s still a burden for us. I don’t know how smaller practices deal with it. Essentially your first swipe at the PA is a website, so someone is taking a patient’s medical record and actually typing it into an online form to see if it will fit exactly cookie-cutter into this form. The patient is not cookie cutter. There is no way to cookie cutter every patient, no matter what the specialty or situation.”

Some states have pursued legislative solutions to PA problems, but with little success, as insurance companies and their lobbyists come out in droves in opposition. As non-physicians increasingly attempt to dictate health care delivery, the Medical Association is committed to finding solutions to PAs and other related issues so that we keep health care decisions between doctors and patients.

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