After much outcry, UnitedHealthcare announced that they are no longer moving forward with their controversial prior authorization policy that would require members to get approval from the insurance company to receive a diagnostic colonoscopy to detect cancer. Instead, UnitedHealthcare has discussed implementing an alternative: an advanced notification process that would require physicians to collect and submit patient data before performing non-screening and non-emergent colonoscopies. This latest policy change is yet another example of the barriers that often bar patients from getting critical, potentially life-saving colonoscopies in a timely manner.
Hurdles in front of physicians
Doctors often cite that insurance barriers have led to serious adverse events such as hospitalization, permanent disability, or death for a patient in their care. That same report from the American Medical Association concluded that nearly half (46 percent) of physicians reported that prior authorization has led to higher utilization of health care services like immediate care and/or emergency room visits.
Understanding patient attitudes toward colonoscopies is relatively straightforward. For decades, studies have shown that although patients understand the importance of screenings, many dread the preparation and struggle with anxiety before the procedure. Over time, physicians and health care providers have worked with patients to reduce their anxiety by providing patient-centric education. Further setbacks in the form of prior authorization rules will only impede patients’ accessibility to critical colorectal cancer screenings, compounding existing challenges even when psychological barriers are overcome.
Prior authorization has a profound impact on physician burnout. The burden of paperwork and spending more time engaging with an insurance company can not be underestimated — excessive workloads and administrative tasks are among the top reasons cited for burnout among physicians across the country. It is imperative that we remove the barriers that are increasing physicians’ chances of burnout — and for the gastroenterology field, this is especially important. Colonoscopies are one of the most provider-dependent procedures; in one study, gastroenterologists’ adenoma detection rates ranged from 7.4 to 52.5 percent. Adenoma detection rates can vary due to the time of day the patient is seen, the amount of patients the physician has already seen that day, and other external factors. With colorectal cancer rates skyrocketing, physicians aim to prioritize delivering higher-quality gastrointestinal care.
Utilizing tech and advocating for more support
According to a survey from the American Gastroenterological Association, 95 percent of respondents say that prior authorization restrictions have impacted patient access to clinically appropriate treatments and has led to worse patient clinical outcomes. It should be considered a feat that UnitedHealthcare ultimately rolled back their prior authorization rule, but in order to prevent occurrences like this from happening in the future, physicians must make their voices heard and stakeholders must act.
Hospitals can implement cutting-edge technologies to alleviate administrative burdens and support clinical decision making, but it is paramount that we implement technology in tandem with advocating for less restrictive red tape. Importantly, responsible use of medical procedures is everyone’s responsibility in order to keep costs under control — not just physicians. Cost should not be the limiting factor that prevents patients from getting the right treatment or the right diagnostic assessments in a timely fashion. Often, rules from insurance companies are broad and sweeping and impact the care of many more patients than intended. At the end of the day, as a physician, you have a front-row seat that shows just how wide-reaching the ramifications of such a policy can have on your patients. It is my hope that we have a more holistic view of care and care delivery so that new policies reflect patient needs.
Shrujal Baxi is an oncologist.
