New England Journal of Medicine July 27, 2023

NEJM Commentary Article by Kyle and Song in July 27,2023 Issue

What’s Interesting about this article?

  • Prior authorization is the number one source of frustration for practicing clinicians. Mandated by insurance companies, it requires multiple phone calls or faxes by busy clinicians or their staff to justify payment for hospitalizations, medications, or diagnostic procedures.
  • Current procedures result in higher medical costs, clinician frustration and burn-out, with little impact on reducing utilization of services.
  • CMS has proposed switching to electronic prior authorization with portals for both patients and provider, with insurer decisions within 7 days for standard submissions and 72 hours for expedited requests. Required details would be automatically transferred from the electronic health record.
  • CMS forecasts savings of 10-20 billion over 10 years.

JournalDoc Comments:

  • Use of the electronic medical record has resulted in an additional 2-3 hours of extra time for busy clinicians. Switching prior authorization to a platform that relies on the EMR will be greeted with great skepticism by health care providers.
  • Insurers will be reluctant to change because current system results in lower costs and higher profits for them.
Link to Article in PubMed

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