By: Sarah Sams, MD, FAAFP
Reprinted from the winter 2018 issue of The Ohio Family Physician.
Administrative burdens are becoming more and more of an issue, whether you serve in an independent practice, hospital system, or an educational institution. The added work load in staff time to complete forms, patient’s delay in care, and added physician administrative time is contributing to the burnout that physicians are experiencing all across the United States.
As an associate director of the Grant Family Medicine Residency Program in Columbus, OH, I not only experience these burdens firsthand as a practicing physician, but also worry about how these trends are affecting our future generation of physicians.
It is for those reasons that I felt it was important for me to advocate and testify, on behalf of the Ohio Academy of Family Physicians, in support of Senate Bill (SB) 129, a proposal that sought to reform and simplify the prior authorization processes used by insurance companies.
On May 25, 2016, SB 129 passed the Ohio General Assembly. The first provisions of the legislation took effect in January 2017, with additional provisions implemented in January 2018. As family physicians, we are advocates for our patients’ health care. Throughout any legislative process, whether we are in support of the bill or not, it’s important for Ohio lawmakers to hear the voices of family physicians, representing thousands of patient stories from across Ohio.
The passing of SB 129 was a huge win for family medicine, lifting an enormous administrative burden off the backs of family physicians and their practice teams. Prior to that, prior authorization forms transitioned from cost considerations into a review of treatment practices. As a result, these forms would often request pertinent medical history and included questions regarding diagnoses, risk and benefit, alternatives, effectiveness, stability of symptoms, side effects, and other considerations.
Not only did prior authorization cause an immense amount of frustration for patients and physicians, it also delayed much needed treatment, and in some cases put patients at risk. The bottom line is that for many of us, we treat our patients like family, which is why we want to get them the medication or treatment needed in a timely manner. In 2016, in my testimony I said, “Physicians often feel powerless when advocating with payers on behalf of their patients.” But that’s not how I feel today.
I feel empowered knowing that my voice was heard, that my patients’ voices were heard, and that there is one less obstacle in health care preventing my patients from receiving the medications and treatment they need. We know from experience that insurance companies are putting their bottom line before our patients, which is why we can never stop fighting.
As family physicians, we must constantly address administrative hassles in medicine or we are going to have a greater problem in achieving and maintaining a sufficient primary care workforce to provide care to an aging population.
There is still work to be done. Another bill, SB 56, regarding step therapy requirements has been introduced in the past two legislative sessions. We have continued to testify on this additional piece of legislation which would decrease additional administrative burdens and help our patients get the treatment that they need. The battle is not over, but we will continue to advocate on behalf of our patients.
Note: On January 4, Gov. Kasich signed the step therapy legislation.