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March 19, 2018

In This Issue
IN THE SPOTLIGHT
President Proposes Cutting Opioid Rx by 1/3, Death Penalty for Sellers, Other Measures
Congress Confronts Another Must-Pass Spending Bill Deadline: March 23rd
New AMA Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization
RWJ Foundation Releases County Health Rankings & Roadmaps Report
Maine Quality Counts Publishes new "Choosing Wisely" Toolkit for Employers
Diabetes Alert Day - March 27: 3 Strategies that Change the Conversation You Have with Patients on Type 2 Diabetes Prevention
MMA Board Approves Climate Change Resolution
Bipartisan Group of Senators Propose Bill to Ban “Gag Clauses” on Prescription Savings
Do you hold a DEA X-waiver to prescribe buprenorphine?
128TH MAINE LEGISLATURE
Legislative Call This Tuesday, March 20th
Legislative Report: Female Genital Cutting, Medical Marijuana, and More
Med Student/MMA Board Member Knowland Testifies on Student Loan Bill
Governor Approves Meningococcal Vaccine Rule
UPCOMING EVENTS
QC2018: Building Communities of Practice through Innovation - Wednesday, April 4, 2018
MMA and Jackson Laboratory Seeking Volunteers to Assist with 2018 Maine Cancer Genomics Initiative Forum - April 6-8
FREE 8-Hr. MAT Waiver Training Being Offered in Dover, NH - Friday, April 27th
Introduction to Lean in Healthcare Full-Day Workshop on Tuesday, May 8
New Free CME on Alzheimer's Risk, Detection, and Management
Peer Navigation Program from Facing Our Risk of Cancer Empowered (FORCE)
Online Learning Opportunities Offering CME Credits - from the Northern New England Practice Transformation Network
HEALTHCARE EMPLOYMENT OPPORTUNITIES
Medical Board Physician
Outpatient Only - Internal Medicine with Loan Repayment & Sign-on Bonus
Family Practice Physician - Bucksport Regional Health Center
Hospice Physician – Lewiston, ME
Internal Medicine Outpatient Physician
Operations Director
Outpatient Internal Medicine Physician – Bangor, Maine
Relocate to Beautiful Southwestern Maine - Medical Director/Family Practice Physician
Clinical Cardiology Opportunity
Opportunities at the VA for Volunteer Physicians

 
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New AMA Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization

More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey released today by the American Medical Association (AMA). The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed.

“Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” said AMA Chair-elect Jack Resneck Jr., M.D. “In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care. In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.”

According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said they wait three business days or longer.

The high wait times for preauthorized medical care have consequences for patients. More than nine in 10 physicians (92 percent) said that the prior authorization process delays patient access to necessary care; and nearly four in five physicians (78 percent) report that prior authorization can sometimes, often or always lead to patients abandoning a recommended course of treatment.

In addition, a significant majority of physicians (84 percent) said the burdens associated with prior authorization were high or extremely high, and a vast majority of physicians (86 percent) believe burdens associated with prior authorization have increased during the past five years.

The survey findings show that every week a medical practice completes an average of 29.1 prior authorization requirements per physician, which takes an average of 14.6 hours to process—the equivalent of nearly two business days. To keep up with the administrative burden, about a third of physicians (34 percent) rely on staff members who work exclusively on the data entry and other manual tasks associated with prior authorization.

“The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care,” said Dr. Resneck. “In response, the AMA has taken a leading role in convening organizations representing, pharmacists, medical groups, hospitals, and health insurers to take positive collaborative steps aimed at improving prior authorization processes for patients’ medical treatments.”

In January 2017, the AMA with 16 other associations urged an industry-wide reassessment of prior authorization programs to align with a newly created set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other health care organizations have supported those principles.

In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association in a Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

Earlier this month, the AMA and Anthem announced a collaboration that would include, among other goals, identifying opportunities to streamline or eliminate low-value prior-authorization requirements and implementing policies to minimize delays or disruptions in the continuity of care.

To further support prior authorization reform, the AMA has recently produced and released the following educational videos.

  • Video #1 highlights the new AMA survey and illustrates that the undue burdens of preauthorizing medical care and drug treatments have reached a critical level.
  • Video #2 highlights the real opportunity to improve patient experiences while significantly reducing administrative burdens for both payers and physicians by reforming prior authorization and utilization management programs with electronic prior authorization (ePA) that integrates within the electronic health record workflow.
  • Video #3 highlights how physicians can start using ePA and what the AMA is doing to help.

The AMA welcomes the opportunity to work collaboratively with health plans and others to create a partnership that lays the foundation for a more efficient prior authorization process. Please visit the AMA website to learn more about the organization’s ongoing collaborative efforts.

 

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