Why a leader calls on insurance companies to do nothing about pre-authorized
Dr. Jesse Ehrenfeld, former president of the American Medical Association, said the healthcare system’s reliance on pre-authorization was a waste of clinician time, delaying care and aggravating public distrust — but, according to Dr. Jesse Ehrenfeld, former president of the American Medical Association, there was little urgent need for payers to fix it.
He was interviewed last week Medcity News‘Investment Conference in Chicago.
Dr. Ehrenfeld noted that previous authorization processes often result in significant delays in patients’ access to necessary procedures.
He still works as a practice anesthesiologist in Milwaukee, and whenever he meets a patient, he usually asks them how long it takes to schedule the surgery and how long it takes for them to get their insurance company to approve it. Dr. Ehrenfeld said patients usually wait twice as long for approval for their health plans as they schedule surgery.
“I heard about frustration. I heard about the challenge of having third-party payers do what they should do, namely, covering services. [prior authorization] It really adds delay and confusion. We conducted survey data year after year, showing that patients gave up – patients did not get their needs. It’s an overused heavy tool that is frustrated with everyone. ” he declared.
Dr. Ehrenfeld noted that despite CMS’ proposed reforms to its normative planning standards and transparent plans, these changes do not apply to the broader commercial insurance market, Dr. Ehrenfeld noted.
He also noted that despite the reforms, he still saw abuse in the market.
“Doctors of companies are building AI tools to handle this process and fight these denials. And, according to media reports, we know that third-party payers are using automation tools to deny care. So we make robots beat robots, which is not the best use of anyone’s time or effort to build technology to oppose each other, and react in our case, which is reforming in our case.
He picked out the Medicare Advantage program because it has some of the worst abuse authorizations.
Overall, Dr. Ehrenfeld believes that unnecessary and heavy prior authorization processes are a waste of medical staff’s time. He said it consumes dozens of hours a week and withdraws clinical staff from patient care.
Dr. Ehrenfeld added that the problem is exacerbating the workforce crisis in health care. Clinicians continue to leave healthcare workers, often overturned by excessive burnout caused by administrative overload. There are more than 2 million clinician positions nationwide.
The United States is also dealing with the growth of aging population and rising chronic morbidity rates, which adds to two other factors that have already extended system demand.
Dr. Ehrenfeld said: “All of these administrative matters add burdens and steal time from clinicians.
It is also worth noting that this is a question of public anger.
The widespread disdain for Americans to deal with payers after former UnitedHealthCare CEO Brian Thompson shot and killed in New York City.
“The whole situation was bad, and I was terrified of his family and him, but the national response to it – lack of empathy – was extraordinary. It was a clear sign of a completely broken and dysfunctional system. I think Americans are good people. I’ve been meeting people, I’ve been having a lot of discord and anxiety there, but I’ll see you say, I’ve told you, I think, I think, I think, I think, I think, I think.
Still, the healthcare industry has not seen commercial payers put in a lot of effort to address public dissatisfaction with their practices – unless strengthening security for executive leaders is a kind of accountability.
Dr. Ehrenfeld is frustrated that third-party payers are doing nothing. Despite consensus and public pressures, insurers’ practices, especially outside of CMS supervision, have little meaningful changes. The AMA urges Congress to intervene to address the wider abuse of business plans that CMS reform does not cover.
“[The AMA]Sincerely, it has been spent years to develop a range of principles surrounding best practices with prior authorization. There is one thing about these tools – we’re not saying they shouldn’t be used, but they’re overused and are tedious in terms of implementation. So we sit down with the National Medical Directors of most major companies and develop in a consensus format, what this should be like. These principles are there. They are available for free and then the payer ignores them altogether. ” said Dr. Ellenfeld.
For him, the signs of rejecting these consensus-based principles suggest that commercial insurers are willing to reassure.
“It’s frustrating to let us sit at the table and try to help how to do the right thing for Americans to improve the health system and then throw it out the window,” Dr. Ehrenfeld said.
Photo: Elena Lukyanova, Getty Images
