Saturday, December 19, 2015

Prior Authorizations, Drug denials, and Big Brother IS Watching.

This is a rant.

Doctors are getting inundated with prior authorization forms for prescription drug refills this year.

  • Drug companies are limiting the number of pills per month, even if the pill doesn't come in the right dosage and the patient has to take two pills a day or the larger dose is too big to swallow, so they need to take 2 smaller pills.  They will only approve one pill a day unless you get prior authorization. Prior Authorization is a form the doctor has to fill out, reviewing ALL the other medications you've ever taken in that class, and why you have to have that specific drug in the quantity you need it. 
  • Drug companies are denying certain generic drugs now, in favor of OTHER generic drugs.
  • Drug companies are sending us lots of letters for patients whose drugs will no longer be covered in 2016 with suggestions on which drugs to change them to. 
  • Insurance companies send us letters telling us that our patients aren't taking their drugs as prescribed based on refill pick ups. I get those in big envelopes with 10-20 patients to review.
  • insurance companies are sending us reminders that our diabetic patients should be on a certain type of blood pressure pill and on statin drugs, without understanding the nuances of the patient's medical problems. Sometimes you just CAN'T for a MYRIAD of reasons.
  • Insurance companies are driving us NUTS. 
If you think big brother isn't watching, think again. 

I suspect that in the future, patients will be held responsible for a larger premium or portion of their bills based on adherence to therapy, medications, weight loss, diet and exercise and follow up appointments. 

I have to prove that my Medicare diabetics are checking their sugars by having a copy of their blood sugar logs in the chart

I have to fill out a form giving the diagnosis, diagnosis code, and last Hemoglobin A1C and justify why my Medicare patient is testing their blood sugars more than once or twice a day.

If a Medicare patient is getting home care, I have to fill out a "Face to Face Encounter Form" on which I need to explain the LAST office visit (within 90 days of start of therapy) and why the patient is home bound. Then, the latest slap in the face is that they don't BELIEVE us that we saw a patient on such and such a date. We now have to send a COPY OF THE LAST NOTE with the form. 

I understand that fraud is prevalent. I've reported it myself. Home Care is rife with fraud. It drives me NUTS that the doctors who are honest and hard working are getting buried by paperwork. It is MADDENING!

I am part time. 

I spend at least 15-20 hours a week doing paperwork. This is in between seeing patients in the office, going to the hospital, and making the occasional home visit. 

I don't get paid for paperwork or phone calls. 

A lot of the paperwork is solely to make insurance company's bean counters happy. It is to fill out flow sheets, document that our patients have had all of their health maintenance procedures (vaccinations, colonoscopies, mammograms, Bone densities, PSA's, lipids, glucoses, etc.) so they can decide what form of payment they will provide to the organization. It's all couched under patient safety, and it IS helping, but really, do I need to be a clerk? 

Instead of collating that information on their own through the use of shared claims data, they make physicians become clerks. 

I am a highly paid clerk. 

Just so you know, when it takes 1-2 weeks for me to fill out your YEARLY FMLA form so you don't get fired for taking off work for that pesky asthma attack or killer migraine, that is why. 

I am drowning in  paperwork. 

DoctorDiva 12/19/15

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