Need-to-Know News, Permission Request, Someone’s Watching & You Don’t Say

Need-to-Know News, Permission Request, Someone’s Watching & You Don’t Say

Need-to-Know News, Permission Request, Someone’s Watching & You Don’t Say 2011 1491 AEPC Health

May I?

As children, we were taught to ask permission before doing something for safety reasons or as part of learning respect for others. We longed to be a “grown-up” in order to have the perceived perk of no longer having to ask permission to do things. Little did we realize that even as adults the practice of asking permission would still be required, like asking a supervisor for time off. Or as a medical doctor, requesting an insurance company’s approval for a patient’s treatment through a utilization management process known as prior authorization (PA).

Finding a fan of the prior authorization process among the patient or provider community is not easy, if not impossible. According to a recent survey by the American Medical Association, over 90% of physicians reported that prior authorization process can negatively impact patient care by extending waiting periods for treatment. Many doctors view prior authorizations as an attack on their autonomy, their years of training, and their ability to care for their patients. Patients dislike the hassles and delays in receiving the care for which they have coverage.

The objective of the PA process is to control healthcare costs by reducing unnecessary or inappropriate medical care. Wide-spread use of utilization management programs began in response to rising costs following the establishment of Medicare and Medicaid programs in 1965. In the mid to late 1970s, employers and organized labor were also facing rising healthcare costs, inflation, and unfavorable economic conditions. In 1978, a labor-management group comprised of the former Secretary of Labor, the CEOs of eight major corporations and presidents of seven large labor unions developed a position paper in which they voiced support for utilization management programs (subject to collective bargaining), HMOs, health education and other actions to combat rising costs.

Over the years, public and private sector efforts to combat healthcare costs through utilization management have evolved to where we are today – laying the foundation for where we will go in the future.

Read about the current debate surrounding prior authorizations in Permission Requested!

Happy reading,

Suzanne Daniels

  • Need-to-Know News: current healthcare news, including federal judge strikes down preventive care ACA benefits, what’s next, & gloomy state of US life expectancy..
  • Permission Requested: CIGNA denies prior authorization (PA) requests without review, PA delays care, & reducing PA burden.
  • Someone’s Watching: tracking opioid settlement money, “black boxes” to reduce error & update on hospital price transparency.
  • You Don’t Say: including my personal favorite, 70 Words (and Phrases) You’re Probably Using All Wrong!

Enjoy the weekend!

Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]

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