Prior Authorization Explanation
Updated 3/10/2020: REASONABLE QUESTION EXPLAINED: WHY WOULD YOU GUYS STOP DOING PRIOR AUTHORIZATIONS (TEMPORARILY)?
This is Dr. Marks. I appreciate and respect your stance on the topic (sincerely). Frankly, I agree with the frustration. Above all, we are still doing everything we can to assist people with PAs, but we need our patients to at least try to do whatever they can. When patients message us through the portal and request help, as of now we are tending to the issues and taking care of the PAs for them. This may or may not be sustainable for the foreseeable future. Let me give you my perspective on this matter, as I have an ethical obligation toward the safety of our patients and staff (and I’m realistic):
We are in uncharted territory. There is a legitimate possibility that medical offices throughout any given city (as well as business, schools, etc.) will be forced to close down for indefinite time frames – whether due to our own staff getting sick & needing to call out or from a governmental entity mandating such. I have made it clear to my staff that if they are sick, they should not come to work in order to mitigate the risk of bringing any untoward illness into the office and spreading it to others – whether Covid-19 or not (let’s face it – most people who have it are not actually getting tested and have no idea they have it). As a patient at our office, I bet you’d rather that the person who checks you in, takes your vital signs, or treats you medically is not coughing all over you. I feel the same way. So do 8,000 other patients in our practice. And their families. And mine.
Our staff spends, cumulatively between all of them, approximately 50 hours per week doing PAs (5 people x 2 hours/day). Probably more. What should we expect when one of them is sick? Two? Three? They’re humans. Just like you and me. They’re scared. If a critical mass of people are ill, I will be forced to shut down the office temporarily. If you think that other offices aren’t in the exact same position, you’re wrong – they just may not be planning ahead as much as I do (or not telling you their plans). Who do you think is going to be doing the PAs for patients when the clinic is closed and everybody is sick? Do you think the call center, which almost every practice in town uses, would to be fully functional with sufficient capacity to tend to every phone call (they’re humans too)?
Firefighters are quarantined in Washington State right now. Schools are closing down.
Twitter & Facebook aren’t going to SXSW. SXSW was cancelled. Countries are closing their borders and ceasing trade. Italy is closed. We are facing a potential economic impact that far surpasses anything the modern world has seen, and we have no idea what to expect. If I don’t prepare our patients for the reality that we will very likely not have the staffing capability to take care of PAs on their behalf, then patients are going to have a false expectation and won’t know what to do if/when the time comes. I’m doing what everyone else is going to be doing – I’m just telling people in advance and not pretending that things won’t change. I’m planning on your behalf while our team is at full capacity and we have time to do so. I don’t want to have these policies. I also don’t want to get Covid-19. Reality is, many of us will get Covid-19, and we all need to deal with new realities. Like it or not, our patients must be prepared for us not being fully functional when it happens.
I sincerely hope you understand my perspective. I assure you, it’s not out of laziness or lack of desire to help people. It’s the exact opposite. My hope is that, if the worst case scenario were to take place, there would be some relaxation of the need for prior authorizations by the insurance industry so patients could get the care they need in a highly strained medical environment. Until then – and even then – we’re still here to help you via the patient portal.
-Robert S. Marks, MD