Imagine stepping into a hospital under the pretense of receiving care, yet what you get isn’t truly what you need, and you still need to pay for it. A 2017 research article written by Heather Lyu, et al, states that “Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary.” This reality isn’t particularly uncommon for many Americans, which is why I believe we must reform Prior Authorization.
Prior Authorization — a process of approving a health plan before a patient receives specific services or prescriptions– is used to combat unnecessary care. One example of this prevention revolves around drug use and issues that could arise regarding said drugs. It can prevent wrongful prescription, as physicians must “Refer to the patient’s insurance plan drug formulary before prescribing a costly drug.” This would reduce the load on a patient by reducing the financial pressure of an unnecessary drug.
Prior Authorization is nowhere near perfect, however. In many studies, it has been noted that Prior Authorization can put lots of strain on clinicians and clinical processes. That is why I urge a digitalization of Prior Authorization to lessen this strain. That way, more facilities can utilize Prior Authorization practices for their patients, easing the process of addressing medical needs and eliminating the possibility of unnecessary care.
Digitalization of Prior Authorization could improve the time and reduce the effort of each authorized plan for each patient. If electronically done, this plan could also be shared between team members easily, as well as neighboring hospitals or care centers. That way, facilities can keep easy track of a patient’s needs no matter what happens or where the patient goes.
Through these reforms, unnecessary care rates would decrease, and many patients would benefit. The time it takes to implement these reforms could vary, but the effort and time saved would make it worthwhile. Patient satisfaction and safety are the most important factors, and both would also benefit from the digitalization of Prior Authorization.
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