AMA House of Delegates

AMA meeting: AMA urges Web system for prior authorizations

Delegates agree that online systems would help practices meet insurer requirements.

By Pamela Lewis Dolan — Posted June 29, 2009

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The use of Web-based prior authorization services could help physicians reduce the amount of time and money spent on dealing with insurance companies, according to policy adopted by the AMA House of Delegates.

The policy calls for the Association to support federal legislation requiring all health insurers to include Web-based services among options for granting prior authorization.

"I've known for a long time it was costing me a lot of money to deal with insurance companies and I realize you all know that, too," said Charles Hoffman, MD, an internist and delegate from the Oregon Medical Assn., which introduced the resolution.

Dr. Hoffman said a recent Health Affairs article put the problem into perspective with a report that each U.S. physician spends, on average, $70,000 each year resolving insurance-related issues.

Dr. Hoffman said the idea for the resolution came from his nurse-managers, who told him several insurers offer Web-based services, which are quicker and more efficient than spending several hours on the phone, the way disputes have traditionally been resolved.

The Health Affairs study, published online May 14, found that practices' interactions with insurers cost $23.2 billion to $31 billion a year. Primary care physicians were found to spend the most time -- estimated at more than four hours per week -- dealing with insurance issues, compared with other specialists.

Last year the AMA launched its "Heal the Claims Process" campaign to address the obstacles physicians face in getting paid for care. The AMA found physicians spend as much as 14% of their revenue on efforts to get paid promptly and for the contracted amount.

The Health Affairs report called for health plans to invest in making claims payments faster and more accurate, but didn't specify a need for Web-based systems for prior authorization.

There was some discussion at the House of Delegates' June Annual Meeting as to whether the issue should be addressed at the state or federal level, as insurers sometimes have different plans in each state they serve.

Lynn Parry, MD -- a neurologist who is an alternate delegate for the Colorado Medical Society but spoke for herself on the house floor -- said making it a state-by-state issue would only give the insurers an excuse not to implement the systems in states without laws.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said the group is in favor of any health information technology that helps streamline the administrative process.

The group joined the AMA and other national health care groups in signing a letter to President Barack Obama that detailed ways the health care system could reduce its spending by at least $1 trillion.

AHIP supported a mandate on the use of technology to streamline five key administrative functions: claims submissions, eligibility, claims status, payment and remittance.

Zirkelbach said within the next month AHIP will pilot a Web portal in two states to allow physician practices to interact with all contracted insurers through one site.

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Meeting notes: Medical practice

Issue: Guidance and policy is needed on the use and release of physician data.
Proposed action: A Board of Trustees report provides physicians guidance on the release and use of their data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements and patient satisfaction measurement requirements. [Adopted]

Issue: Solutions are needed to address overcrowding in hospital emergency departments.
Proposed action: A Council on Medical Service report congratulates the American College of Emergency Physicians for developing solutions to the problem of overcrowded emergency departments. The report also supports collaboration between organized medicine and ED staff, and the dissemination of best practices, in efforts to reduce ED boarding and crowding. [Adopted]

Issue: Certain specialists are required to be in-house on a 24-hour basis at some hospitals. Some are not paid for this in-house coverage while others are.
Proposed action: The AMA work with the American Hospital Assn. to require the equitable treatment of all specialists required to provide in-house coverage. [Adopted]

Issue: The growth of the hospitalist movement has resulted in less hospital volume for some physicians. This has made it difficult for low-volume physicians to demonstrate clinical competencies in a hospital setting, as required by some credentialing rules.
Proposed action: The AMA adopt guidelines to assist medical staffs with credentialing and privileging physicians with low activity. [Adopted]

Issue: As employees of physicians, allied staff, including nurse practitioners and physician assistants, have little contact with the activities of organized medical staff, especially concerning patient care, safety, quality and ethical issues.
Proposed action: The AMA study how hospital medical staffs can involve allied staff in oversight activities. [Adopted]

Issue: Radiology benefit managers interfere with patient care and place an unnecessary burden on physicians and compromise patients' health by substituting tests or denying approval for tests.
Proposed action: Oppose routine denials or substitutions by RBMs working for third-party payers, study the prevalence of forced substitution of one study over the one requested, support the use of appropriate-use criteria developed by physicians with expertise in the specialty that pertains to the patient's condition. [Adopted]

Issue: Electronic medical records place the purchaser at the mercy of a vendor when the system needs fixing or upgrading. Open-source coding allows users to make changes and update as necessary.
Proposed action: Ask the AMA to develop open-source EMRs that meet "meaningful use" criteria, and make them available at a nominal cost to physicians. [Adopted]

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