Seventy-nine percent of medical groups said that payer prior authorization requirements increased in the last year, according to a March poll conducted by the Medical Group Management Association.
Here are three leaders' thoughts on prior authorization:
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The biggest issue with Medicare is the ever-increasing regulatory and documentation burden. It is getting more difficult and requires more practice resources to stay compliant with all of their regulations, most of which do not actually benefit patient care. For example, the recent development of requiring prior authorization for cervical fusion surgery made it much more difficult to get those operations done in a timely manner.
Kenneth Nwosu, MD. Spine surgeon at NeoSpine (Burien and Puyallup, Wash.): My biggest industry concern is the ever increasing barriers by payers to provide high value care to our most vulnerable patients in a timely fashion. Over time, it appears that the default decision for procedures needing prior authorization is a denial, as indicated by a rising number of peer-to-peer reviews where the reviewing physician openly states that the ordered surgery should not have been denied. Alternatively, I am seeing more denials where a peer-to-peer review time is dictated by the payer, which is often in conflict with the treating physician's availability. In some instances, there is not an option to partake in a peer-to-peer review following a denial.
Nick Jain, MD. DISC Sports & Spine Center (Newport Beach, Calif.): While prior authorization for [anterior cervical discectomy and fusion] is an obvious target due to the increased authorization process burden and delay in care, I think the decreasing CMS fee will prove to be the most detrimental recent change to patient care. As reimbursement costs decrease while staffing costs and inflation soar to all-time highs, physicians will be forced to spend less time with patients to make ends meet, resulting in shorter face-to-face visits with an increasingly sicker and older patient population who require our full attention and dedication. This will only lead to the further degradation of the physician-patient relationship and, for that reason, I would eliminate the recent cuts to the CMS fee schedule.