The biggest threat to the gastroenterology industry

Prior authorization has become one of the most talked about issues in gastroenterology in 2023. 

Benjamin Levy III, MD, a gastroenterologist at the University of Chicago Medicine, spoke with Becker's to discuss the threat prior authorizations pose to gastroenterology. 

Note: This response has been lightly edited for length and clarity.

Question: What is the biggest threat to the gastroenterology industry?

Dr. Benjamin Levy: There are a couple [threats] concerning gastrologists nationally. One is the talk of increased prior authorizations. This is just potential requirements for prior authorizations for screening colonoscopies and diagnostic colonoscopies that have recently been proposed and then they were tabled.

No matter what kind of physician you are, prior authorizations are something that physicians are concerned about because of the amount of extra time required to take care of those phone calls. On average it takes about 20 to 30 minutes per prior authorization for a physician outside of their clinic time. So anytime we have to do that, we have to set up the prior authorization and frequently it requires talking with several different people at an insurance company just to set up the prior authorization. It doesn't matter whether it's for a procedure or for a medication to get approved, we have to take time out of our schedules, in terms of taking care of patients, in order to have a conversation with the insurance company. Physicians who are well trained are making very good decisions clinically about workup and management of their patients. So instead of taking care of another patient that same day, we're ending up spending time with the prior authorization process.

In addition to that, the insurance company that proposed potentially doing this decided to cancel that plan and instead are talking about doing an advanced notification. That still requires a lot of time from clinic staff. It takes away our attention to actually try to get to see more patients, and practices potentially could have to hire additional staff in order to take care of any kind of advanced notification or prior authorization process. It just makes healthcare more expensive because you have to hire more staff to take care of these additional requirements. All physicians want to make healthcare more efficient with less red tape and to be able to quickly take care of patients. Whether it's in terms of scheduling a procedure because they're having a concerning symptom like weight loss, concerning rectal bleeding or new onset anemia, we want to be able to expedite those patients and take care of them and not have additional requirements set on this that interfere with patient care.

There are several problems with it. One, it could potentially delay care. If anything's ever rejected because of this prior authorization process or an advanced notification process, some of the patients may be lost to follow up because they get frustrated about the process. It's hard enough trying to get all of our patients to follow up on their care, 100% of the time. So any kind of barriers that are placed could interfere with patients getting their procedures performed.

All physicians want to make healthcare as efficient as possible and have the ability to expedite things as quickly as possible. We hope that in general, all insurance companies will work closely with our GI societies, including the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. We hope that insurance companies will work with our GI societies who advocate on behalf of patients in order to make gastrology care as efficient and as good for patients as we possibly can.

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