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What Keeps You Up At Night? (Part 4)

This is the last in a series of articles looking at current healthcare issues presented at a meeting of health system CFOs in 2017.

Prior Authorization   
A December 2016 survey by the AMA showed 75% of practicing physicians said that prior authorization is a huge burden for themselves and their staff.

While the vast majority of services requested through prior authorizations are approved, 59% of respondents to a recent AMA survey said they had to wait for a PA decision from one to five (or more) business days.

In response, the AMA, AHA and 14 other healthcare organizations drafted 21 principles to aid in reforming prior authorization requirements. This was intended to build a dialogue between providers, health plans and their third parties thus eliminating wasteful administrative costs.

The principles focused on five broad categories:

  • Clinical validity

  • Continuity of care

  • Transparency and fairness

  • Timely access and administrative efficiency

  • Alternatives and exemptions

Prior authorization recommendations included:

  • Policies should be based on clinical criteria instead of costs

  • Prior authorization should apply to services, drugs or devices only

  • Forms should be detailed and reviewed for all necessary information

Many of the principles outlined by the coalition were common sense solutions, focusing primarily on transparency. Health plans should improve the process of transmitting information on treatments that require prior authorization.

For the full report, click here.


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