Should Docs get paid for time spent on pre-clearances?


CHICAGO — Should medical practices be paid for the time they spend on pre-approvals? Members of the American Medical Association’s (AMA) House of Delegates seemed divided on the idea.

Prior authorization “is something that has really become a burden,” Andrew Cooke, MD, representing the Florida delegation, said Saturday during a referral committee hearing at the annual meeting of delegates from the United States. WADA. Delegates were debating two resolutions that called for the development of Current Procedural Terminology (CPT) codes to reimburse physicians for time spent appealing denied claims and filing prior authorizations. “I think we should support both of these resolutions because they go to the heart of what we want, and that is to get paid for what we do and the services we provide.”

Megan Srinivas, MD, MPH, speaking on behalf of the Council on Medical Service, disagreed. “We don’t want to undermine our current advocacy efforts,” which focus on changing the prior authorization system, Srinivas said. “We are focused on building coalitions with patient advocacy groups to highlight the harm that prior authorizations cause to patients. We would undermine this by saying we are okay with abusive denials as long as we are paid for it. Moreover, health plans are unlikely to even agree to pay physicians for prior authorization, especially since most network contracts stipulate that physicians are subject to prior authorization obligations.

But Zuhdi Jasser, MD, of the Jasser Center for Comprehensive Care in Phoenix, who spoke for himself, had a different opinion. “Even though I completely sympathize with all the work that our AMA leadership is doing to build coalitions, why can’t we have multiple leads that say, ‘You know what, if we fail here, we’re also going to advocate to be paid for it. … If Path A through the coalitions fails, we will now start asking to be paid for the time we have, because it’s no longer fee-for-service, it’s pay-for-time.”

AMA President-elect Jack Resneck, Jr., MD, speaking on behalf of the board, said that while prior authorization is “overused, expensive, inefficient and opaque,” the board s always oppose resolutions. “I don’t want to do anything that legitimizes a broken process by asking me to be paid for something that’s totally broken,” he said. Resneck noted that the association had listed fixing the prior authorization process as one of the pillars of its recovery plan for doctors. “I’m sick of pre-clearance, but we’ll fix it.”

Delegates also discussed a resolution calling on the AMA to advocate for legislation or regulation that would designate claimant burnout as a repetitive stress injury subject to Occupational Oversight. Safety and Health Administration (OSHA). “We are very pleased that the AMA has addressed the issue of physician burnout and prioritized the well-being of physicians, and all the work they have done in this area,” said Bonnie Litvak. , MD, speaking on behalf of the New York delegation.

“The reason the New York delegation is asking for this to be looked at is because we need to use all the tools at our disposal and look for ways to improve this, and this, which is a repetitive injury, falls under the OSHA can give our doctors greater protection, and it can also help our healthcare systems really prioritize the well-being of doctors.”

The Section of Women Physicians agrees. “We absorbed collective issues day in and day out, and then all we do is wash our hands between patient rooms — we’re expected to be robots,” said Anna Laucis, MD. , MPhil, alternate delegate for the section. “But we’re not robots, we’re humans. So that should be recognized as repetitive strain injury, especially in the context of the COVID-19 pandemic, dealing with life and death repetitively.”

But Tatiana Spirtos, MD, a California delegate speaking on behalf of the PacWest delegation, said her group opposed it “primarily because we’re concerned that making it an OSHA issue would subject so all the injuries that happen under workers’ compensation, and we feel that’s a bad way to look at burnout as a work-induced injury. So for that reason, because we don’t want to go down that rabbit hole, we oppose this resolution.

Liz Davlantes, MD, speaking on behalf of the CDC, recommended referral to the committee for further study. Although the issue of physician burnout “is in dire need of attention, and has detrimental effects, the use of the quoted definition of repetitive stress and strain injury is less than ideal”, she said. “This definition is clearly written for repetitive physical acts…and is not an ideal definition to refer to repeated psychosocial stressors leading to burnout linked to poor mental health outcomes.”

Instead, OSHA’s “general duty” clause might be a better fit, she said. “The General Duty Clause obliges the employer to provide employees with a safe workplace free from recognized hazards called ‘likely to cause death or serious bodily injury to employees’. It can be strongly argued that stressors in many health care settings can lead to serious injury or death, so this definition may be more applicable Long-term political support for a specific national mental health standard similar to those seen in Canada and the UK Kingdom would be ideal to deal with this type of serious risk.

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. Follow


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