Physicians Voice Frustration Over Uncompensated Work

Marcia Frellick

October 09, 2018

NEW ORLEANS — The aggravation family physicians feel about the amount of uncompensated time they spend providing documentation for prior authorizations was evident as reference committee testimony began on Monday here at the American Academy of Family Physicians (AAFP) 2018 Congress of Delegates.

Some who testified cited a lack of proof that prior authorizations decrease costs — to patients or the insurance companies — but pointed out there is evidence that they delay care and increase physician burnout. Currently, there is no disincentive for insurers to issue prior authorization requirements, one speaker pointed out.

A resolution put forward by the New Mexico chapter asks that AAFP work with the American Medical Association to establish time-based Current Procedural Terminology codes specifically to compensate physicians and staff who complete the authorizations. It also asks for AAFP to advise the Centers for Medicare and Medicaid Services and, if necessary, Congress to require payers to pay for this time.

Some delegates suggested eliminating prior authorizations for physicians with a proven track record of responsible prescribing and ordering.

Five dollars does not pay for 3 hours of my time, or my staff's time.

Gary Plant, MD, an alternate delegate from Oregon, said he likes the idea of compensation for time, but worries that an unintended consequence of this would be that costs would fall on patients, so protections would be needed.

He reported that during background talks about the resolution, a $5 fee for each authorization was mentioned.

"Five dollars does not pay for 3 hours of my time, or my staff's time," he said. "If a policy like this were to pass, it would create additional billing requirements and additional documentation requirements, with very little gain for the primary care office."

Arnold Pallay, MD, a delegate from New Jersey, said there should be no prior authorization at all, but rather retrospective reviews that hold physicians accountable.

Skip the Prior Authorization and Review Later

Although getting paid for the documentation would be nice in the short term, he said, a long-term fix would be better. For instance, MRI ordering could be unfettered but then reviewed at the end of each quarter to see whether a physician ordered too many or too few.

"If you don't fall within the standard deviations, there has to be a reason given for it," he said.

Kandie Tate, MD, from Washington, DC, who is chapter president and a delegate for AAFP, a practicing family physician, and a consultant for an insurance company she declined to name, said that prior authorizations are needed to keep costs in check. In her role as a consultant, she said, she sees that some physicians abuse the system.

We're trying to bring down the cost of medicine.

"People are incorrectly trying medications, as well as labs and imaging, that result in higher costs. If you're starting a medication that's never been tried before, just made it to the market, insurance isn't going to pay for that. Yes, they are great medications, but there are cheaper versions that work just as well," Tate told Medscape Medical News.

"If you try it and it doesn't work, yes, we'll keep going until we find something that works," she added, "but you don't go for the most expensive first."

Because payers have to cover large populations, a decision for one patient takes away options for another, she added.

She said she commonly sees orders for MRI that lack supportive documentation and provide no explanation of what else has been tried and why there was no x-ray.

"We're trying to bring down the cost of medicine," she said.

Update: On October 9, the delegates voted to refer this issue to the board.

Plant and Pallay have disclosed no relevant financial relationships. Tate reports consulting for an insurer.

American Academy of Family Physicians (AAFP) 2018 Congress of Delegates. Presented October 8, 2018.

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