The program will allow qualifying providers to skip the prior authorization process for a number of procedure codes.
Several providers have expressed hope over the program, believing it will potentially be of benefit, while others have expressed doubts.
Yeshvant Navalgund, past president of the Pennsylvania Pain Society, medical director at National Bioskills Laboratories and founding member of the American Society of Regional Anesthesia Special Interests Group in Pain Management, told Becker’s that he doubted this move would be in the best interest of patients.
Dr. Yeshvant Navalgund: The concept of a gold card Program as it is currently proposed, only places the leverage back in the hands of the insurance carrier. This will force providers to comply with care models that are “approved” by the carrier. If we are to champion the best interest of the patient, who ultimately is the recipient of care, then there must include accountability for cost shared by the insurance company, patient and provider. This is achieved by cost savings incentives directed at the customer, namely the patient, and if the patient is compliant with care, the provider is conscious about the care using specialty-specific, evidence-based models, and [the] insurer is incentivized to provide reimbursement when each of these criteria are met, this model may have a sustainable opportunity. For these reasons, I don’t feel the current proposed model will benefit providers or patients.
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