Q&A
Discussion of prior authorization processes and efforts to reduce administrative burden on doctors
0:39:16
ยท
133 sec
Dr. Mitch Katz explains the challenges of prior authorization processes for medications and procedures, and discusses strategies to reduce the administrative burden on doctors.
- Prior authorizations are often used by insurance companies to create obstacles and discourage doctors from ordering certain tests or medications
- Katz proposes delegating prior authorization tasks to other staff members, such as physician assistants or administrators
- He emphasizes that the doctor's role should be to determine the order and indication, while others can handle the communication with insurance companies
- The goal is to free up doctors' time for more direct patient care and reduce administrative burdens
Mitch Katz
0:39:16
Well, if the doctor again, there is the you have to remember that the major reason the insurance companies create prior authorization
Gale Brewer
0:39:26
Mhmm.
Mitch Katz
0:39:26
Is to create an obstacle.
0:39:29
Mhmm.
0:39:29
Because they know that most doctors won't wanna spend 20 minutes.
Mercedes Narcisse
0:39:34
Correct.
Mitch Katz
0:39:35
My doctors will, but most doctors won't.
0:39:38
Mhmm.
0:39:39
And that's what the whole system is based on.
0:39:41
So, we wouldn't be asking someone else to to decide what the indication is.
Mercedes Narcisse
0:39:46
No.
0:39:46
What I'm saying
Mitch Katz
0:39:47
say, we what I do, so here's how it works a little differently.
0:39:52
In my where I'm working right now, it's a a physician assistant, and I say to him I I send a text, and I say, can you do the prior authorization for this medicine?
0:40:05
Mhmm.
0:40:05
The indication is x.
0:40:07
And one of the reasons that this works well is that he batches them because you will spend 15 minutes on the telephone till you get to the phone.
Mercedes Narcisse
0:40:16
Might as well.
0:40:16
Mhmm.
Mitch Katz
0:40:17
So he holds them till the end of the day, and then he does them altogether.
0:40:22
If I do mine, I'm gonna have to deal with that 15 or 20 minute thing as long as I'm clear to him what the indication is.
0:40:32
Mhmm.
0:40:32
And, again, if you just remember, it's mostly about creating an obstacle because they could just as easily, create a box that I would just check diabetes.
0:40:44
Mhmm.
0:40:44
I know in the case of the the medicines that we're the GLP one, inhibitors.
0:40:50
I know that if the person has diabetes, they're going to approve it.
0:40:54
So why do I have to do why can't I just check the box?
0:40:58
Because that doesn't create an obstacle, and the insurance companies are trying to create an obstacle to expensive medications or expensive procedures, hoping that a certain number of doctors will say, you know, I'm sorry.
0:41:12
Your insurance won't pay for it.
Mercedes Narcisse
0:41:14
Let me have a clear understanding.
0:41:16
For you, you have a PA.
0:41:18
You can kind of, like, delegate that.
0:41:20
But in the setting of the hospital where the doctor's working, do they have a PA or nurse practitioner or nurse helping them out to get those prior authorization?