Tim StapletonProviding their patients with the best possible medical care is the top priority for physicians. It’s why they became doctors in the first place — to care for people.
But there is too much bureaucracy standing between Florida physicians and their patients. The Florida Medical Association is proposing legislation this session designed to reduce needless red tape and to allow physicians to give patients the right treatment at the right time.
In an FMA survey of the state’s doctors this fall, a quarter of respondents reported spending more than 15 staff hours a week on requesting prior authorizations from insurance companies. Different insurers can have dozens of different prior authorization forms doctors must complete, depending on the type of insurance coverage the patient has.
This is a heavy administrative burden that ultimately deprives patients of time with their physicians. It also makes health care more expensive. Studies have shown that the burdensome prior authorization process is costing the health care system between $23 billion to $31 billion per year — about $85,000 per physician.
During the 2014 session, the FMA will pursue legislation aimed at streamlining prior authorization. Several states, including Texas, California and Ohio, have already passed legislation to create a standard prior authorization form.
The FMA also is responding to physicians’ concerns about “fail first” or “step therapy” protocols that insurers use to assure that doctors prescribe the least expensive drug in any class first — even if they think a different therapy is in their patients’ best interests. The FMA’s survey revealed that 64 percent of respondents have experienced these protocols.
Our legislation seeks to enable physicians to provide the treatment or medication that they deem best for patients at the right time. There is no reason for people to endure needless suffering due to ineffective treatment or drug regimens when their physicians believe that better options are available. Doctors have undergone years of training to make smart decisions and they should be allowed to do so without unnecessary interference.
Forcing patients to try less expensive medications and treatments to save money doesn’t just potentially threaten their health. It can also end up costing more. Ineffective treatment means more trips to the doctor and pharmacist, which take time away from work. The end results for Florida are lost productivity and increased insurance premiums.
Our legislation calls for the following:
- Appropriate safeguards with any fail-first system so that patients do not face weeks or months of ineffective treatment. If a physician reasonably believes, based on sound medical judgment, that a fail-first protocol is likely to be ineffective or will likely cause harm, an override of the fail-first restriction should be granted within 24 hours.
- If a physician agrees that a fail-first protocol is warranted, the duration should not be any longer than a period deemed appropriate by the physician.
- If during the fail-first period the physician deems the treatment clinically ineffective, the patient should be able to receive the recommended course of therapy without requiring an override of the fail-first protocol.
Relieving physicians’ prior authorization burdens and enabling them to exercise their best judgment is the right thing to do. It also saves our health care system and the state money. The FMA will fight for these common-sense solutions during the 2014 legislative session to help physicians practice medicine and to protect the patients they serve.
