The key factor leading physician money loss? Prior authorization

When Becker's asked six top physician leaders what is losing them money right now, the answer was clear — prior authorizations. 

As inflation increases surgical costs, the majority of physicians feel as though payers are not keeping up. Prior authorizations lose physicians time and money, and they make adequate patient care more and more difficult. 

Question: What is losing physicians money right now?

Praveen Mummaneni, MD. Neurosurgeon at UCSF Health (San Francisco): Prior authorization is losing physicians money right now. It takes time for the physician or their nurse practitioner team to call the insurance company for authorization for every MRI scan, every surgery, every small procedure. These requests are typically approved, but they suck enormous time from the physician and their team.

Anthony Bevilacqua, MD. Surgeon at Sports Medicine & Orthopaedic Center (Suffolk, Va.): 

1. Surgeries being canceled at the last minute because insurance decided they wanted something else.

2. Visits with patients being downgraded, if an injection was done and paying only for the injection.

3. Progressive cuts to insurance reimbursements.

4. Insurance unwilling to renegotiate contracts with appropriate rates.

5. Increased expenses due to ever-enlarging processes to make the chart appropriate for the payer, even at the expense of making it right for the patient.

Lali Sekhon, MD. Surgeon at Reno (Nev.) Orthopedic Center: Private practice physicians are small business people as well actually providing healthcare. Private practice is like running a corner store. Simple economics suggests decreased salary or increased expenses reduce take-home pay. In no particular order:

1. Reduce physician payments. Over the past few years, reimbursement has tanked. 

2. Inflation increases physician expenses.

3. Poor payer mix. We all lose money on Medicaid and do it as a sense of community, responsibility and service. Medicare is headed the same way.

It amazes me when I do a major lumbar instrumented case in the operating room knowing the hospital, the neuromonitoring company and the implant company and representatives are getting paid better than I am, but I'm finding the surgery and taking all the risk. Time will tell where this all heads. You get what you pay for.

Adam Bruggeman, MD. Orthopedic Surgeon at Texas Spine Care Center (San Antonio): Physicians are losing money every day because they are no longer paid for their value, but instead due to a budget. Reimbursements have failed to even consider the costs of doing business or inflation to a point where even [HHS] Secretary [Xavier] Becerra has discussed that payment concerns have led to instability in the healthcare field. Long-term payment reform is necessary to provide sustainability.

Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: The biggest time suck of all right now is the quadrupling of prior authorizations I am doing. There is a sizable uptick in the amount, demand and unreasonable denial of care for patients. I have had denials put in for patients with cancer, for routine scans and medications. I have even seen colleagues in other specialties have insurers demand their curriculum vitae. Without reform and without linking authorization to payment, the insurers will drive the healthcare system over the edge. Many insurers have become "too big to fail" as a result of non-enforcement of existing laws, and will continue to do so if left unchecked. 

Doug Blaty, DO. Spine Surgeon at Inland Northwest Spine (Coeur d'Alene, Idaho): Simply put, overhead plus expenses divided by reimbursements. That ratio is getting higher and higher. Overhead goes up as cost to run a practice rises with electronic medical record expenses and unnecessary insurance requirements that change every year. Employee salaries are required to rise as the price of living increases as well. All while physician and hospital reimbursements trend downward year after year. Many are minimizing this ratio, but there will be a critical threshold where you cannot cut anymore, and your practice and income suffers, while patient care will likely suffer as well.

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