Cardio Metabolic Health Congress – Official Blog

The Burden of the Prior Authorization Process

In December 2017, the American Medical Association (AMA) fielded a web-based, 27-question survey distributed to 1,000 physicians. The national sample was comprised of 40% primary care physicians and 60% specialty physicians, all of whom provide 20 or more hours of patient care per week, and routinely complete prior authorizations (PAs) in their respective practices. The collective results of the survey indicated “the significant impact that prior authorization policies can have on both patients and physician practices.”

From a physician impact standpoint, 84% of physicians claim that the burden associated with PA for both physicians and staff is very high. Moreover, 86% report that PA burdens have increased over the past five years, with 51% reporting a ‘significant’ increase. Results further demonstrated that the average total PAs per physician each week totaled 29.1, translating into approximately 14.6 hours spent by physicians/staff to complete the workload. A staggering 79% of physicians claim that they are ‘sometimes, often, or always’ required to repeat PAs for prescription medications, when a patient is stabilized on a treatment regimen for a chronic condition.

Not surprisingly, the PA burden is ultimately passed to the patient, with 92% of patients reporting care delays if their treatment requires PA. Average wait time for PA responses from health plans are at least one business day for 64%; 30% wait at least three business days. Perhaps most alarming is the high percentage of patients—21% ‘always or often,’ 57% ‘sometimes—that convey the correlation between PA and treatment abandonment. An alarming 92% report that PA can have a negative impact on patient clinical outcomes.

The PA burden is a recurring issue that can be found throughout all medical specialties; a recent survey conducted by the American College of Cardiology found that 78% of surveyed cardiologists cite the documentation and administrative burden associated with PA to be a barrier in terms of using newer therapies.

At CMHC, we are dedicated to improving patient outcomes, which often include the inherent burden of the PA process. The 13th Annual Cardiometabolic Health Congress in Boston, taking place from October 24-27, will feature a satellite symposium: Mastering the Prior Authorization Process to Meet Patient Needs. This flipped-classroom approach will utilize infographics, patient case studies, resource center, and a clinician forum to post questions, which will be answered by expert clinicians in the field.

Childhood Obesity Epidemic Worsens

Childhood obesity in America is on the rise, and at rates higher than previous studies suggested, according to a study published Monday in the journal Pediatrics. The findings emerged after researchers analyzed federal data from the latest National Health and Nutrition Examination Survey, the “gold standard” in childhood and fitness research which every two years collects data about adult and children obesity across the country.

In 1999, according to the survey, about 29 percent—more than a quarter—of children ages 2 to 19 were overweight. By 2016, that figure rose to 35 percent, according to the latest analysis, and about one in five children are obese.

Asheley Cockrell Skinner, an associate professor at Duke University and lead study author who has worked with these data for more than a decade, said she has seen in her research that “once a kid has developed obesity, it’s a lot harder to change it. It’s much easier to prevent obesity than it is to reverse it.”

What distressed Skinner most in her research, she said, was the fact that she couldn’t “even find a subgroup of age or gender or race where there seemed to be real improvement.” The largest increases in obesity were seen among children ages 2 to 5. And the risk was highest among teens age 16 to 19 and the Hispanic population. In these groups, four out of 10 children were at risk of being overweight, the most recent survey results showed.

In an editorial that appeared in Pediatrics with the study, David Ludwig, who studies nutrition and obesity at Children’s Hospital in Boston, said cautioned against “over-interpreting short-term trends for complex chronic diseases,” but wrote that public health solutions to obesity “have largely failed so far.”

One positive step from lawmakers in Washington, Ludwig wrote, would be forming “an interagency commission on obesity to align food policy with public health and current science.” He also recommended re-evaluating school lunch standards and the Supplemental Nutrition Assistance Program (SNAP) to put more emphasis on ‘nutritional quality, not just quantity.”

“The battle against childhood obesity faces many obstacles, most notably entrenched special interests and a ‘business as usual’ mindset,” Ludwig wrote. “But with political will and collaboration across key sectors of society, we can hopefully, soon, begin to end this worsening epidemic.”