In a time when the Delta variant is raging and post-acute patient care is needed most, this is not the time for setbacks or bureaucracy. Leave it to insurers, though: Medicare Advantage plans are preventing hospitals from discharging patients for post-acute COVID-19. It’s led to not only a prior authorization pile-up but also, more direly, a hospital bed shortage.
Per a recent article in Modern Healthcare, Medicare Advantage plans are making it difficult for hospitals to discharge patients. This kind of bureaucracy—which claims to be in the patient’s best interest—actually prevents agility in care when it is most needed.
Louisiana, Florida, and Oregon are all states known for their slow approval of care. These states also happen to be experiencing a heavy influx of Delta patients. It’s gotten so bad that some states are calling on the Centers for Medicare and Medicaid Services for aid, which is encouraging, but not requiring, that authorization requirements be relaxed during the pandemic.
Seems clear to us that the only people who should be making decisions about what happens in a hospital should be the people in the hospital. Insurers don’t see it that way, though.
When we’re not in a pandemic: prior authorizations create a gap between the providers who know you best.
When we are in a pandemic: prior authorizations totally block providers from triaging or making decisions based on what’s currently happening in their hospital.
We doubt the paper-pushers approving or denying these claims have even the faintest idea of the horrors that doctors on COVID-19 wards see each day. But if these same providers don’t play by insurer rules, it just comes back to bite them.
At the end of the day, it just reiterates a point we’ve made over and over, pandemic or no—why are we requiring clinicians to get insurer approval before they are able to make decisions in the best interest of the patient, and all the other patients in their region?