Prior Authorization a Hot Topic at Quarterly Practice Manager Luncheon

Practice Managers from around Columbus gathered in the CMA’s board room to grab a tasty lunch, catch up with colleagues, and learn more about the day’s topic: public policy and political action with guest speaker Malcolm Porter last Wednesday.

Porter, the CMA’s political policy and affairs consultant, started off by explaining the current environment of medical care with the many transitions and uncharted waters that have developed in recent years. “A lot of transition has come out of your hides … not only managing your physicians but all the stakeholder entities that you have to deal with,” Porter said.

Porter referenced this graph when saying “For every dollar that is spent, for every good and service, of our entire economy, almost 1 in 5 if you were at 20 percent, 1 in 5 would be spent in healthcare.”

The discussion continued with Porter pointing out how much more the United States spends on health care as a country compared to our economic competitors. Porter highlighted that the U.S. is close to 20 percent for healthcare GDP spending, “For every dollar that is spent, for every good and service, of our entire economy, almost 1 in 5 if you were at 20 percent, 1 in 5 would be spent in healthcare.”

By describing the current environment, Porter explained that advocacy work can be used in effort to change the trajectory of these issues. “Policy is based on a response to all of this” said Porter as he went on to list medical care specific policy that is currently in Ohio’s legislation like telehealth, scope of practice and maintenance of certification (MOC).

An attendee giving her opinion on on prior authorization

However, one issue hit home for the practice managers more than the others: prior authorization implementation. Some stated that they fully supported the bill when it first came out, but now feel it can’t live up to what it promised because many patients are self-funded with ever changing insurance. Prior Authorizations have become increasingly cumbersome and frustrating for those who work with patients with chronic conditions, they also added. Porter fully understood, saying “What should happen isn’t always actually happening,” adding that becoming active in policy could influence some change to that process.

Porter invited those attending to join the CMA’s public policy group, which is open to all. “As a voice of the physician’s community we raise appropriate questions and concerns to have influence on legislators,” Porter said. He added that more practice managers in the group would fill some knowledge gaps, stating “You guys have insight where a lot of the doctors don’t.”

To register for the next Practice Manager’s Luncheon please visit here.

For more information on the CMA’s public policy group go to www.columbusmedicalassociation.org/advocacy