We’ve said it before, and we’ll say it again: Prior authorizations are a bureaucratic bad idea.
At least, they are for physicians and patients.
But while prior authorizations can be a minor inconvenience for some, they can have dire consequences for others. Dan Hurley, who had an aggressive form of cancer, passed away in August. It’s not lost on us that his family cited the terrible state of U.S. health coverage in his obituary.
Prior to his passing, Intelligencer investigated Hurley’s case. According to an article in Intelligencer, Hurley had mysterious back and hip pain for months. He finally went to see an orthopedist, who diagnosed him with metastatic dedifferentiated chondrosarcoma — cancer in his pelvic bone. Hurley’s cancer was spreading. And his pain was mounting. But each time his doctors recommended a new course of treatment, his insurer denied it. “It really feels like they’re trying to kill you,” Hurley said. “I know they’re not, but that’s what it feels like.”
Unfortunately, Hurley’s story is not unique. And criticism of insurers is growing because of it.
Physician groups have lobbied. Patients like Hurley have protested. Lawmakers have proposed new legislation to Congress.
But why did prior authorizations start in the first place? How did we get here?
According to the article, starting in the 1960s hospitals began conducting reviews to find the most cost-effective treatments for patients. Insurers soon adapted this practice, too — but for themselves. When prior authorizations first began, insurers only utilized them for expensive procedures, such as cancer treatments or innovative medications. But now insurers use them for just about any procedure, treatment, or medicine. It’s become “a whole cottage industry,” writes Intelligencer.
Insurers’ logic? To save patients money from expensive procedures and to keep them safe from unnecessary treatments. (Both of which make no sense, since all these prior authorizations don’t seem to be creating any particular savings for patients, and the fact that doctors have the medical degree to recommend what is necessary.)
We’ve talked about prior authorizations before. Health insurers like prior authorizations because they save them money. Physicians and patients don’t like prior authorizations because they delay or deny needed care and create an unnecessary amount of paperwork.
Prior authorizations can cause patients serious harm. According to an American Medical Association (AMA) survey of 1,001 physicians, 33 percent of physicians reported that prior authorization led to a serious adverse event for a patient in their care.
They also waste doctors’ time. The typical physician submits 45 prior authorizations per week, according to the AMA survey. This results in a lot of paperwork, and often requires extra staff to help with the administrative burden. This is problematic for the many hospitals that are already short-staffed. If a doctor’s submission is denied that doctor might even have to get on the phone with a representative from the insurance company to argue why the treatment is necessary for their patient.
The bottom line is this — when insurers play doctor, no one benefits except the insurer.
