Docs Blame Prior Authorization

[somarco]

As for Medicaid expansion and Marketplace it help a bit because we were seeing tons of uninsured but Medicaid's reimbursement is horrible like Medicare and marketplace like you said often has extremely high deductibles.

Originally DC wanted to end DSH supplemental payments . . . from their throne of wisdom, the DSH subsidy was no longer needed since "everyone" would have insurance.

Of course that is theory, and has no relation to reality, so the DSH program was continued (at least for a while).

My guess is that hospitals are pretty much the same or worse than before and hospitals that rely mostly on Medicaid are doing what they can to stay afloat. Smaller public hospitals in Atlanta have searched for alternate funding but that usually falls short. Our "charity" hospital (supported mostly by taxpayers) had made significant shifts in levels of care and even raised Rx copays for low income people but still relies heavily on local taxation for support.

Last year Wellstar closed a 450 bed hospital in downtown Atlanta as well as a smaller satellite hospital south of Atlanta. Both hospitals served primarily low income individuals.

"Free" healthcare is unsustainable, even with significant taxpayer subsidies.

 

[somarco]

Contributing to the problem . . .

About 15% of nonelderly American adults have past-due medical debt, the majority of which is owed to hospitals, according to a new analysis.

https://www.fiercehealthcare.com/hospitals/15-adults-have-past-due-medical-debt-much-owed-hospitals

 

[sshafran]

One in three physicians blamed prior authorization for a patient's serious adverse event, including hospitalization, permanent impairment, or death, according to a survey

Has prior authorization ever prevented a serious adverse event, hospitalization, permanent impairment, or death?

 

[Todd King]

I wonder if hospitals have to take the Hippocratic Oath like doctors do. I think it is clear that they do not.

 

[rmhaire]

One in three physicians blamed prior authorization for a patient's serious adverse event, including hospitalization, permanent impairment, or death, according to a survey

Has prior authorization ever prevented a serious adverse event, hospitalization, permanent impairment, or death?

If it leads to the dreaded Under Observation admission then yes.

 

[somarco]

I wonder if hospitals have to take the Hippocratic Oath like doctors do. I think it is clear that they do not.

Can't say if HOSPITALS have to take the Oath, but I doubt it, since they are run by business folk, not physicians (with a few exceptions).

In all honesty, carriers and govt entities (CMS) set the rules for which claims will be reimbursed, which will not. Providers play the game but somewhere along the line the patient usually gets squeezed and care takes a back seat to economics.

 

[rousemark]

 

[rmhaire]

In all honesty, carriers and govt entities (CMS) set the rules for which claims will be reimbursed, which will not. Providers play the game but somewhere along the line the patient usually gets squeezed and care takes a back seat to economics.

Years ago I had an ambulance take my mother to the emergency room. Lymphedema. Couldn't walk. They refused to admit her due to her age. When the ambulance got her home I had the EMTs ride around the block and come back. Picked her up again and took her Phoebe. They admitted her "Under Observation".

Dismissed her after 5 or 6 days. She never saw a doctor nor a PA. Just nurses. But they did feed her and let her watch tv.

A few months later she got a bill from Phoebe for a little more than $15,000. I knew that neither Medicare nor her supplement was going to pay because of her admission.

I took the bill and wrote "This bill is under observation" in big red letters. And mailed it back to Phoebe. Almost 10 years ago. No phone calls, no collections, no nothing.

It's always about the economics.

 

[StephanieCJ]

In the event of an emergency situation, PAs can be done retroactively with proper documentation.

 

[somarco]

In the event of an emergency situation, PAs can be done retroactively with proper documentation.

Does the carrier really do a retro PA (which is an oxymoron) or just waive the requirement administratively?