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It’s Always About Choices

Grace Torres-Hodges, DPM, MBA explains that patients have choices and need to know their options; Doctors need to understand they have options and their choices have consequences.

It’s always about choices.

As the patient, you have choices.  You can choose your doctor based on specialty.  You can choose your doctor based on location. You can choose your doctor based on gender.  You can choose your doctor based on network.  You can choose your doctor based on reputation.

But Doctors have choices too – to contract with an insurance company or not.  That decision to be within a network should not change the doctors’ capability of treating you, right?

If a medical office relies on third party authorization, that means there is someone else in the exam room determining if something is medically necessary. The physician must wait for permission to proceed. The bottom line?  It’s no longer simply a doctor – patient relationship.

The patient is in front of the doctor.
The patient has been examined by the doctor whom they have been entrusted with their care.

AND YET, that doctor needs permission to treat?

…prior authorization for a referral
…prior authorization for prescription
…prior authorization for a test
…prior authorization for a procedure

In February 2022, a Medscape article reported that 33% of doctors saw a patient harmed by prior authorization. That’s only 1/3 complaining — does that mean the other 2/3 are OK with this way of patient management?  Doubtful.

I don’t think you can convince my patient ,who still has his foot despite having an infected diabetic ulcer, that prior authorization is helpful.

 

I don't think you can convince my patient ,who still has his foot despite having an infected diabetic ulcer, that prior authorization is helpful. Click To Tweet

 

His insurance company denied the authorization request by another doctor. The office had submitted medical notes that contained a clinical assessment.  However, the insurance company declined to pay for an MRI – they wanted the doctor to pursue conservative treatment first.

His wife sees me as a patient and convinced him to come in. I agreed with other doctor’s initial assessment and sent him for an MRI.

BUT I told him to ask for the cash price.

The patient found it less expensive than what his co-pay would have been had his insurance approved the previous doctor’s request.  Armed with the information I needed, I initiated my treatment of surgical debridement and saved his foot.

Insurers will say authorizations are needed to cut costs.

But authorizations have been around for well over 30 years…have you taken a look at the growth in healthcare costs over that same time period?

That doesn’t even consider if they are counting ALL the costs.

…not just the physician visits
…not just the diagnostics
…not just the surgical procedure

But also for the doctor –

…additional time on a computer
…additional time away from another patient
…additional staff to follow-up

and for the patient-

…time off work, loss of income
…risk of worsening condition due to delayed treatment
…loss of limb or death

Patients have choices, and they need to know their options.
Doctors need to understand they have options as well and their choices have consequences.

It’s always about CHOICES!

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