Physicians like myself are already investing heavily, both in time and dollars, in health information technology, known as “health IT” or electronic medical record systems. These systems allow us to see each patient’s full medical history and communicate with other health care providers and pharmacies with the click of a mouse. Health IT systems even allow us to send prescriptions to the pharmacy while we’re still visiting with the patient.
But because of insurance-related roadblocks, that’s where the power of this technology screeches to a halt. Even though most health IT systems can enable physicians to see which medications are covered by a patient’s health care plan – and even electronically obtain a “prior authorization” asking the insurer to cover a certain medication – insurers won’t provide access to this plan information, or allow doctors to obtain prior authorizations electronically.
So while I can electronically prescribe a medication, my patient can still be denied the treatment hours later at the pharmacy. At that point, I have to call and fax the insurance company in a process that takes days or even weeks. Meanwhile, my patient’s condition can get worse.
Fortunately, the South Carolina General Assembly has an opportunity this year to mandate that insurance companies give health IT systems access to health plan information and the ability to electronically request prior authorizations for treatments that might not be covered. Like many physicians, I am willing to work through insurer policies to make sure my patients get the treatments they need, but it’s time for the prescription process to join the 21st century.
The American Medical Association recently released a membership survey on prior authorization which found that 69 percent of physicians typically wait several days to receive prior authorizations for their patients, while 1 in 10 wait more than a week. Meanwhile, health care providers waste valuable time on the prior authorization paper trail. Physicians and their staffs can spend up to 20 hours per week just dealing with prior authorization requests, and studies have shown the costs to physicians nationwide can reach $23.2 billion to $31 billion a year. Pharmacists also find the prior authorization process time-consuming, spending, on average, nearly five hours a week on requests.
Technology has the power to create a powerful, more efficient health care system – but only if all parties involved, including insurance companies, get on board. Our state lawmakers must act to ensure that this occurs. Our state legislators are the only ones who can make sure health IT reaches its full potential by requiring health insurers to join this effort.
The writer, a past president of the Horry County Medical Society and current trustee to the board of the South Carolina Medical Association, is a practicing physician in Myrtle Beach.