How pre-authorization paperwork may ironically raise health costs

Filling out pre-authorization paperwork is among the most frustrating chores a doctor can do.

But it’s going to continue, because of the rampant spending on prescription drugs and diagnostic tests. Throwing more obstacles in the way of doctors is a draconian way Medicare and other health insurers can reduce demand.

And it works. In the short-term anyways.

In a piece from NPR’s Shots, Scott Hensley discusses how Boston’s Massachusetts General Hospital changed its pre-authorization software program to force doctors to justify their tests: “The switch appeared to get doctors more involved in ordering of all scans, too. The proportion of scans ordered directly by doctors increased to 54 percent from 26 percent beforehand.”

Spending time justifying tests takes time which, as we know, isn’t valued in the outpatient setting.

I certainly support more evidence being required before ordering an expensive CT, MRI, or PET scan, but forcing doctors to fill out paperwork, or putting them on hold while on the telephone, doesn’t strike me as the best use of their time. Especially with the rooms filled with patients waiting to be seen.

There’s going to be a breaking point — which some doctors have already reached — where physicians are going to simply refer patients to specialists or to the ER rather than jumping through pre-authorization hoops.

And that, ironically, will only escalate health costs.

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