WHAT HAVE WE DONE FOR YOU LATELY
The Next Chapter in Prior Authorization Reform
BY DAVID WROTEN EXECUTIVE VICE PRESIDENT , ARKANSAS MEDICAL SOCIETY
Very few things get physicians fired up more than the endless onslaught of prior authorizations . Over the past few legislative sessions , AMS has led the fight to address these problems through a series of laws that have resulted in improvements in areas such as access to a physician reviewer , step therapy requirements , transparency , ( i . e ., in the criteria ) turnaround time and more .
While these have helped , one thing continues to frustrate just about everyone . That ’ s the length of time on the phone in order to get a prior authorization approved .
Maybe it ’ s time to take the next step .
Our understanding is that most prior authorizations are approved . If that ’ s the case , why have it at all ? Some carriers point to the “ sentinel ” effect . If you
Leaders in Medical Education know a procedure must go through prior authorization , physicians will take the time to consider if the procedure is really needed or consider an alternative . I ’ m not sure I agree with that .
Maybe it ’ s time to acknowledge that this is an unnecessary hassle that delays patient care and places a resource burden on physicians and their staff . Rather than outright banning the practice , a more measured approach is what is commonly referred to as a “ gold card .” If virtually all your prior authorization requests for a given procedure are approved , why not remove the burden , at least for a specified period of time .
AMS has considered such legislation in the past , but until recently , no one else had any experience with the concept . Enter Texas . The Texas Medical Association passed a gold card program a couple of years ago .
While it has yet to be implemented due to the slow regulatory process , it does give us the blueprint of what such legislation ought to look like . Also , given the issues surrounding the drafting of their regulations , we also have the benefit of learning from their mistakes . By that I mean that TMA learned a lot of things during the regulator process that , had they known it at the time the legislation was drafted , could have improved the law and shortened the implementation time .
We are currently working with a couple of legislators on a draft . I tell you this because you ( all of you ) will need to be engaged with your state senator and state representative in order to get this passed . There is a lot of work to be done and some compromises will undoubtedly need to be made . With your help , this is something that we can achieve that will make your job easier . ■
New York Institute of Technology College of Osteopathic Medicine ( NYITCOM ) at Arkansas State University is committed to training talented physicians who aspire to become servant leaders that positively impact their communities .
Contact us to learn more about the two degree programs offered on our Jonesboro campus :
Doctor of Osteopathic Medicine ( D . O .) Master of Science , Biomedical Sciences
Training Physicians In Arkansas , For Arkansas
nyit . edu / arkansas | 870.680.8816 | ComjbAdmissions @ nyit . edu
42 THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY