Time spent on prior authorizations

[MifflinDunder]

Hey guys. Long time lurker. Current IM resident considering heme-onc

How much time do outpatient heme onc docs spend on inbox messages and prior authorizations vs primary care docs?

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[Mehena]

I don't know much about daily PCP workflow but I would say oncologists deal with this rigmarole more often than PCPs, just based on the sheer volume of scans ordered and new/old neoplastic treatments/indications and supportive measures added by an average oncologist. Although often insufficient, support staff & APPs are there to help depending on your practice setting.
N-of-1 Fellow experience:
VA clinic - no headaches for any study or drug approved ordered.
Safety Net Hospital clinic - tons of that.

 

[gutonc]

Academ-ish community office: I got people for that. I will occasionally have to sign a form. Or do a P2P. But that's like once a week during a bad month.

 

[HemeOncHopeful19]

I love when insurance sends a message “Hey you ordered an MRI or a PET and it will be denied, you need to schedule a peer to peer, if you don’t then the final determination will be made with the information in the chart.”

Like hold up, nobody has even read the chart yet and I’m getting angry letters?

 

[wysdoc]

In Texas the prior authorization rigamarole with insurers was so cumbersome and often led to delays in needed care that TMA lobbied for a House bill which passed. A doctor whose judgement is appropriate such that 90% of their test/referral requests have been approved will get "gold card" status and not need to get prior approval on those requests in the future.
Texas Prepares to Implement “Gold Card” Prior Auth Bill

 

[gutonc]

In Texas the prior authorization rigamarole with insurers was so cumbersome and often led to delays in needed care that TMA lobbied for a House bill which passed. A doctor whose judgement is appropriate such that 90% of their test/referral requests have been approved will get "gold card" status and not need to get prior approval on those requests in the future.
Texas Prepares to Implement “Gold Card” Prior Auth Bill

OMFG that would be amazing. I would say I'm well above that cutoff. I get roughly 2-3 scans (usually PET) denied a year. The rest I get approved on P2P or appeal.

 

[gutonc]

I love when insurance sends a message “Hey you ordered an MRI or a PET and it will be denied, you need to schedule a peer to peer, if you don’t then the final determination will be made with the information in the chart.”

Like hold up, nobody has even read the chart yet and I’m getting angry letters?

Yeah, most of my P2Ps are like that.

"Yes, I'm just reading your note now, that was sent 3 months ago when you ordered the scan, looks like it should be approved, I'll approve it."

The other thing I run into not infrequently is that I just ignore the P2P request, let the original order expire, put the order back in and, voila, it gets approved.

 

[bobsmith]

Academ-ish community office: I got people for that. I will occasionally have to sign a form. Or do a P2P. But that's like once a week during a bad month.

+1 to this. I will occasionally have to clarify some clinical point on a form, but there are people in my office that take care of this stuff for us and I mostly just sign.

In Texas the prior authorization rigamarole with insurers was so cumbersome and often led to delays in needed care that TMA lobbied for a House bill which passed. A doctor whose judgement is appropriate such that 90% of their test/referral requests have been approved will get "gold card" status and not need to get prior approval on those requests in the future.
Texas Prepares to Implement “Gold Card” Prior Auth Bill

This part is also amazing: "Requires that peer-to-peer calls occurring prior to a utilization review denial be conducted by a Texas-licensed physician in the same or similar specialty as the physician who requested the service."