Dr. Phillips says Mr. Sahni’s paper presents interesting ideas, but noted some devil-in-the-details concerns related to electronic PA requirements and payer integration into electronic medical records (EMRs) and real-time eligibility solutions. For example, it’s unclear whether various EMRs are capable of allowing this technology and how its use could slow the workflow if additional steps are needed by a provider when they’re in the room with a patient, adds Dr. Phillips.
Ms. Ruffing
Victoria Ruffing, RN-BC, director of patient education and director of nursing at the Johns Hopkins Arthritis Center, Baltimore, questions how much AI would alleviate PA burden. In her organization, she says, peer-to-peer reviews and the appeals process take up the bulk of time spent on PAs.
Charles F. Haberkern, MBA, chief executive officer of Rheumatology Specialty Center, Willow Grove, Pa., notes PAs for infusion drugs take at least seven days in his practice, which has 18 providers and four full-time employees dedicated to prior authorization requirements. This delay prolongs pain for patients. In addition, many insurers require that physicians and patients use different drugs from what rheumatologists order. If the initial drugs do not work and another appeal is necessary, “the approval time is often months,” he says.
Mr. Haberkern
To deal with PA processes, suggests Mr. Haberkern, rheumatologists must understand each payer’s formulary and preferred medications. “Some payers actually exclude some drugs, so sending authorizations for those can be a time-consuming process often ending in a denial—and a huge waste of valuable time,” he says. Some insurers score physicians according to adherence with company best practices, so he urges practices to try to relieve physicians of PA workload and monitor physicians who may be seen as outliers.
