Listening to his colleagues discuss the challenges of prior authorization with CMS Administrator Chiquita Brooks-LaSure was "sobering and a little bit troubling," Inova Health CEO J. Stephen Jones, MD, told Becker's.
Clinicians and nonclinicians at the Falls Church, Va.-based system recently got the chance to share their challenges in a discussion facilitated by the American Hospital Association.
Dr. Jones noted one story from a surgeon who scheduled a time to set up a call for prior authorization. The surgeon was waiting on the phone for a long time — by definition waste, Dr. Jones said — before finally getting someone on the other end who said "this call is to set up another call for preauthorization."
"That is a surgeon who could be treating someone's cancer or accompanying someone and helping them understand the complexities of their disease," Dr. Jones said.
Dr. Jones said he emphasized to Ms. Brooks-LaSure that the workforce is burnt out and stress has never been higher for those taking care of patients.
"We're seeing people leave the industry and leave skills that they trained for … including their own compassionate approach to dealing with patients," he said. "When they leave the industry, the impact is highly leveraged. Losing one doctor because of the stress of the work that we do means that thousands of patients will not benefit from the skills of that physician."
The effect of losing those physicians and nurses is felt for the decades that would have remained of their careers, he added.
"If we have one physician get so tired from having to deal with the things that get in the way of doing what they are trained and most capable of doing, it's heartbreaking," he said.
Dr. Jones said CMS understands the challenges of prior authorization and wants to address them. Recently, the agency finalized a rule aiming to streamline the prior authorization process and improve the electronic exchange of health information that it estimates will save $15 billion over 10 years.
He said he was grateful for the work of the administrator and CMS and recognizes the situation cannot change overnight, "but this is a very promising step in the right direction."
"The endgame should be that we have essentially real-time authorization for all but the rarest and most unusual of situations," he said. "And I certainly don't know if we would ever hit 100% on that, but we ought to get pretty close.
"For most of the times when we, for example, seek authorization for an imaging procedure, by and large clinicians at Inova and otherwise are ordering these things for the right reasons. So the prior authorization process ultimately ends up approving it being done, but what happens is you have all that cost and friction in the middle and you get a delay in the time in which patients get their care. And importantly, you end up wasting valuable clinical time that can be used on things that matter to our patients."