July 3, 2013 - Physicians, physician assistants, nurses, nurse practitioners, patient advocates and medical societies throughout Oregon jointly celebrated the passage of Senate Bill 382, which reduces administrative duplication, increases medical office efficiencies and speeds prior authorizations of medications. In effect, SB 382 declares it’s time for ‘one form for all.’
Senator Alan Bates, D.O., worked with provider groups statewide to create Senate Bill 382, calling for the Oregon Department of Consumer and Business Services and the Oregon Health Authority to jointly develop standards and a single, 2-page form for providers statewide to use to request prior authorization for prescription drug coverage.
Said Sen. Bates on Wednesday, “Here in the legislature, each member has what we call a ‘take home’ bill. This was that bill for me since my wife is a manager for a busy medical clinic.” He added, “This bill basically cuts through the administrative difficulty from the point of view of unnecessary paperwork for prior authorization of medications. The bill allows us the ability to have one single form for all insurers that dramatically decreases the difficulty of obtaining important medications exceptions for our patients.”
The physicians, providers and groups supporting the bill focused on how standardization will also address the need to simplify administrative and claims processes to improve access, and improve efficiency while reducing redundancy, administrative overlays, workflow inefficiencies and resource costs in clinical care.
Eugene rheumatologist and a leader of the Oregon Rheumatology Alliance, Cody Wasner M.D., said Wednesday, “This is a small but meaningful step toward simplifying the insurance chaos. Finally a move to help the doctors and patients instead of the system.”
The Osteopathic Physicians and Surgeons of Oregon’s Executive Director David Walls noted, “Passage of this bill and the creation of a standardized prior authorization form are steps toward creating greater efficiencies and reducing the administrative burden on physician offices. This is critically important, not
only for reducing costs across the health care system, but for providing greater patient access, specifically in the primary care setting. With reductions in administrative burdens, we can place a greater focus on preventative care services and shift the emphasis of our healthcare system from procedure based interventions, to wellness and prevention.”
In April, Sen. Bates said, “This might not seem like much, but we counted more than 200 separate forms that insurers require Oregon providers to fill out when requesting authorizations so the patient may have needed diagnostic tests, prescriptions, durable medical equipment or access to a specialty physician.” He added, “I’ve shared previously that I figured my clinic staff spends between 20 to 30 percent of our time managing insurance approvals and dealing with insurers, and it’s an incredible impediment to providing patient care.”
Walls noted in April that for his organization’s 900-plus physician and provider members, the prior authorization protocols and forms can be lengthy, time-consuming, and confusing; and that often these forms are not only problematic for physicians; they can be a major barrier to patient access and appropriate treatment. ” Walls added, “A standardized form for prior authorizations would significantly streamline this process, eliminate confusion between the myriad of payer-required forms, and create greater efficiencies in the health care system.”
Sen. Bates added on Wednesday, “We will be adopting a form that is effective and accepted by all payers over the next eighteen months. This will give them time to adjust their procedures to the new, single form that will be uniform across the system. This will not only make it easier to practice medicine but also to have some significant cost savings for all of us in health care.”
Gov. Kitzhaber signed Senate Bill 382 into law on Monday, paving the way for immediate operational improvements for insurers and provider offices, creating a bridge for those who do not yet have electronic charting and patient tracking systems.
This bill is also expected to help prepare providers for the oncoming health information technology transformation (i.e. electronic records systems, claims processing, the medical home and the evolution of clinical practice). Developing efficient, secure data systems was earmarked under ARRA of 2009, the federal stimulus act and many Oregon clinical practices have benefitted. Funding incentives and bonuses are available to providers who use qualifying health information technology. Providers who do not, will receive reduced Medicare reimbursement rates, so incentives exist to use smarter processes and technology platforms.
A survey administered in November, 2010 by the American Medical Association of 2,400 doctors found prior authorization processes pose problems, and that “Preauthorization requirements not only are a source of frustration for physicians, but they also create delays that interfere with patient care.” Various studies found:
· Phone calls and fax communications between pharmacies and physician offices account for up to 25% of pharmacists’ time and 20% of the workload of physician-office staff.
· Nearly all physicians reported that eliminating hassles caused by insurer preauthorization requirements is very important (78%) or important (17%).
· The administrative burden to physicians of dealing with Medicaid preferred drug lists and prior authorization for cardiovascular medicines are estimated to cost $1,000 per physician practice per year; and over $2,000 for practices with numerous Medicaid patients.
Physicians and provider group supporters of Senate Bill 382 include:
Cascade Family Practice
Central Oregon IPA
Cornerstone Clinical Services
Leukemia Lymphoma Society- Oregon, SW Washington, Idaho, Montana Chapter
Marion-Polk County Medical Society
Medical Society of Metropolitan Portland
Oregon Medical Association
Oregon Nurses Association/Nurse Practitioners of Oregon
Oregon Podiatric Medical Association
Oregon Rheumatology Alliance
Oregon Society of Medical Oncology
Oregon Society of Physician Assistants
Oregon Urological Society
Osteopathic Physicians and Surgeons of Oregon
