Here’s the dirty secret of emergency medicine:
We don’t have to do prior auth. Like ever. We just order what the patient needs, and the patient gets it done in the ED.
But here’s why we care about prior auth anyways:
B/c not a shift goes by where a patient doesn’t land in the… twitter.com/i/web/status/1…
Need your gallbladder taken out electively? Too late (waiting for auth), now you’re in the ED with cholecystitis.
Had a “nodule” seen on a CT, but couldn’t get a repeat scan authorized…ever? Now it’s metastatic and you’re in the ED for crippling pain.
DVT? No problem, started… twitter.com/i/web/status/1…
Why does this matter?
1. It’s terrible for patients
2. It stresses the healthcare system in ways it shouldn’t
3. It’s cumbersome and wasteful to insurers and clinicians both
35million priorauths submitted to @MedicareGov #MedicareAdvantage in a year - assuming 5 min/each and $20/hour of staff time (underestimated since this is physician/RN/admin blended time) that’s $58million of just labor cost.
Not including denials/appeals…
Citation: kff.org/medicare/issue…
So why does #priorauth exist?!
To “contain costs” by insurers…
Doesn’t sound terribly cost effective, does it? 😑
$58 million in labor cost alone of initial submission, not including the labor cost of denials/appeals and not including the cost of ED/hospital stays that… twitter.com/i/web/status/1…
@Ambcare_pharmer @sonodoc99 @TakeWeightOffMD Though admittedly the tiers are controlled by PBMs…another mafia middleman in healthcare…
@OregonCascades @AmerMedicalAssn
@marc_mould @george1_morgan @SenWarren But mostly lots of finger pointing by drug companies, insurers, and PBMs…
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