Central PA Medicine Fall 2017 - 26

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Practice Management
"What if I would have died with this?" he said. "Personally, I'm just irritated
that the insurance companies have so much power over doctors trying to
get their patients what they need."
Pittsburgh's Kristen O'Toole experienced delays in getting an MRI for her
back pain. The weeks' long wait allowed her undiagnosed multiple sclerosis
to progress, and she is now in a wheelchair.
"If I had gotten the MRI earlier and started on the infusions, I really believe
it could have kept some of these symptoms at bay," O'Toole said. "Maybe
I would have never ended up in a wheelchair."
"The doctor knows there's a problem here," O'Toole added. "There's
something going on. And how is he going to know before he gets the data
from the MRI?"
Dr. Skubick said his biggest frustration with the rise of prior authorizations
is that it takes the clinical decision-making out of the hands of physicians.
"I think it is incredible that the insurance company would think that a
person who has practiced neurology for 35, 40 years doesn't know more
than somebody on the other end without seeing the patient," he said. "I've
never had a pre-cert denied for any diagnostic study when I'm able to talk
to a colleague that is a neurologist.
"But I'm talking to people (at the insurance companies) who are not even
doctors some of the time. And sometimes when you do get a doctor, you're
getting an internist or a gynecologist - what do they know about neurology?
What do they know about the subtleties about whether an MRI is necessary?"

Physicians Must Be Part
of the Solution
Oncologist Rick Boulay, MD, wrote a recent blog for KevinMD: "Most
patients are unaware of this, but your physician is likely your biggest advocate
when it comes to getting your care covered" from prior auth. Similarly,
physicians need to step up to support new legislation in Pennsylvania that
aims to decrease patient wait times from prior auth.

OPENING DECEMBER 2017:

House Bill 1293, introduced by Rep. Marguerite Quinn (R-Bucks), would:
* Increasing transparency and consistency in prior authorization criteria
* Establishing standards for and reducing the overuse of prior authorization
* Lessen manual processes and enhance the electronic exchange of
information Developing a standard prior authorization form

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26 Fall 2017 Central PA Medicine
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10/24/17 3:36 PM
http://www.dauphincms.org http://www.MiddletownHome.org http://www.pamedsoc.org/PriorAuth
Table of Contents for the Digital Edition of Central PA Medicine Fall 2017
