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Amy Faith Ho, MD MPH Profile picture
@amyfaithho
May 18, 2023 • 9 tweets • 3 min read • Read on X
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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More from @amyfaithho

Amy Faith Ho, MD MPH Profile picture
Aug 7, 2023
Maintenance of Certification (#MOC):
When we (physicians) took our medical degrees, residency training, and commitment to lifelong learning & patient lives…and got duped into paying @ABMSCert millions of $$$ for the privilege (ahem, requirement) of taking time away from the… https://t.co/p3GapNdhkLtwitter.com/i/web/status/1…
Image
Why does this matter?

1. It’s a financial racket, pure and simple. 87.9% of these boards’ revenue come from exam fees…exams which are functionally mandatory since insurances, hospitals and other employers of physicians require it to practice.


2. MOC… https://t.co/BuPdG9164Jjamanetwork.com/journals/jama/…
twitter.com/i/web/status/1…
#ICYMI: Check out / sign this petition by @aarongoodman33 for @abimcert


Plus the podcast where they got millionaire ($1.2millionaire, to be exact) CEO of @abimcert @richardbaron17 to chat #MOC with @aarongoodman33 and @chadinabhan… https://t.co/MotDVheg6bchange.org/p/eliminate-ab…
twitter.com/i/web/status/1…
Read 4 tweets
Amy Faith Ho, MD MPH Profile picture
May 19, 2023
For those just now realizing insurers don’t care if you live or die—

🚨🚨🚨Insurers do not care if you live or die.

In fact, death is highly cost effective, especially if it is fast, and especially if you are chronically ill.

Up to 25% of all Medicare expenditures are spent on… twitter.com/i/web/status/1…
Talking a little more about medical loss ratio (MLR), the ACA actually required that insurers keep to at least a 80% MLR, though there are liberal rules on what can quality as “medical loss” (aka paying for healthcare) beyond just paying for healthcare.

Even with those liberal… twitter.com/i/web/status/1…
Citation:

kff.org/5925efc/
Read 4 tweets
Amy Faith Ho, MD MPH Profile picture
Apr 15, 2023
Why #privateequity in #healthcare is evil…🧵

💰Short-term $ goals of #PE drive the long-term nature of caring for lives. Nothing like devolving a 70-year patient life into a 5-7 year $ projection geared towards the next sell off…
💰Highly leveraged PE ➡️ desperate $$$ decisions(⬇️ staffing, ⬇️access clinics, ⬇️quality/ availability of supplies and treatments)

💰10x more likely for bankruptcy of the healthcare entity

@jama_current jamanetwork.com/journals/jama/…
💰Sell offs➡️ corporate “handoffs”➡️ fragmented care from shuffling insurance networks and doctors available

💰⬆️ cost of care. 💯 about the balance sheet. Look at @hcahealthcare, 12-13x $ markups

hcavsamerica.org/wp-content/upl…
Read 5 tweets
Amy Faith Ho, MD MPH Profile picture
Mar 27, 2023
A snapshot in time confounded by @TheNRMP match “algorithm”. The truth is #medicine is we have work to do in #genderequity - US physician workforce only 37% women. Rads 27%, Gen Surg 22%, #EM 👋🏼29%…@acepnow @WomenSurgeons @AmCollSurgeons @radiologyacr @EmergencyDocs @aawr_org… twitter.com/i/web/status/1…
@AAMCtoday stats on 2021 US physicians by % female. #pediatrics 65%, #orthopedics 5.9%. Note surgical sub speciality ($$$) higher male dominance, medical/primary care higher female…#orthotwitter @aap_peds @aaos1
New generation of US #doctors show progress, by @aamc study on residents and fellows, 47% total female, #gensurg 46%, #radiology still only 27%, #emed 39%…
Based on the @StanfordMed graphic, we can assume why progress for gensurg but why not for Rads…
Read 9 tweets
Amy Faith Ho, MD MPH Profile picture
Mar 27, 2023
So what are #PBMs? Chances are, if your meds suddenly got changed by your insurer, or you’ve been waiting weeks on #priorauth for a med you need, or you pay $$$$$ for a drug in the US that is cheap overseas, you’ve already experienced a #PBM and didn’t even know… twitter.com/i/web/status/1…
That’s b/c #PBMs aren’t meant to be known, they’re meant to be a middleman in healthcare cutting in an extra layer of profit for them and an extra cost to you…wonder why #prescriptiondrug pricing makes no sense compared to prices in other countries? This is why.
Pharmacy Benefit Managers (PBMs) are third party entities paid by healthcare insurance companies to manage all things meds: the formulary (what is/isn’t covered), the price from manufacturer, and the cost (copay or “tier”) to the patient.
Read 9 tweets
Amy Faith Ho, MD MPH Profile picture
Mar 26, 2023
Can’t talk about #womenshealth w/o mentioning #maternal death -unfortunately on the rise in America...how does one of the richest countries have the highest rate of maternal & infant mortality?🧵npr.org/sections/healt… @acog @ACOGPregnancy
We have high c-sx rates, low prenatal care, high chronic disease rates in our mothers. Post-partum care is a single visit at 6 weeks. Working pregnant moms may opt to induce labor for the 'convenience' of optimizing their leave...
Speaking of leave, the US is the one of the ONLY industrialized countries to NOT have ANY paid parental leave. If that doesn't reveal value in a society, I don't know what does. Punchline: the value isn't in family. No wonder our divorce rates and rates of mental health and… twitter.com/i/web/status/1…
Read 6 tweets

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