Friday, June 24, 2016

Insurance Prior Authorization - Hope for Common Sense Changes

The Ohio Legislature is the considering a proposal that makes so much sense it is hard to believe the issue is just now being addressed.  Here to the hope that other states will act quickly and take similar action.

Nothing is more frustrating to patients and physicians than the prior authorization process that requires physician offices to ask permission via telephone from the insurance carrier to treat the patient.

This system is cumbersome, multilayered and lengthy.  This process interferes with the sacred doctor-patient relationship.  Most egregious is the insurers ability to retroactively negate a written approval for care after a patient has received treatment.

Ohio SB 129 has passed the Senate and will be addressed in the State House.  

SB 129 will make the following changes to the prior authorization system in Ohio:
  • create a uniform web-based system for submitting prior authorization requests 
  • establish timeframes within which a prior authorization request must be responded to 
  • ensure that once a prior authorization has been secured, an insurer is not able to retroactively deny coverage for that authorization
  • ensure that all new or future prior authorization requirements are disclosed to the provider community at least 30 days in advance
  • guarantee turnaround on prior authorization requests and quicker turnaround for more urgent requests 
  • mandate that prior authorization protocols use evidence-based clinical review criteria 
  • create a streamlined appeals process in the case a prior authorization is denied
The medical community in Ohio, working with its partners and creating a diverse coalition, has successfully moved legislation to reform the practice of prior authorization.

Friday, June 17, 2016

80 % Chance Your Orthopedic Surgeon Will Not Be There in 2 Years

Hospital corporations and physician groups are merging to create mega corporations in response to the ACA.  Hospital corporations and large group practices are hiring Orthopedic Surgeons as corporate employees.  There are fewer private practice small group Orthopedic Surgeons in our country. Young physicians do not feel confident enough to get a loan and join/start a small practice.


After 10 years of training including medical school, residency and fellowship one would think young surgeons would be ready to find their dream job and settle in for a long and productive career.

An unintended consequence is dissatisfaction with the hospital or large group employment model.  These young physicians are 80 % likely to change jobs within their first 2 years of practice.


Friday, June 10, 2016

Orthopedic Surgery Practices Greatly Enhance State Economies

A study out of Missouri discovered the tremendous economic impact of an orthopedic surgery
practice to the state economy.

Each orthopedic surgeon supports the equivalent of 3 small business.

In Missouri the impact was $1.79 billion in total economic output and $600 million in household earnings.

11,100 jobs were generated.

$28 million in state taxes.

Orthopedic Surgeons are vital contributors to state economies.

State legislators --  take note.

Friday, June 3, 2016

Behind the Scenes of Healthcare Reform

Congress has made changes to physician requirements for Medicare providers.  Some of these regulations put added regulatory burdens on physicians which results in loss of productivity.

Two such examples are the quality metrics data requirement and the Value Based Payment program (which is being phased in over several years).

The quality metrics program found that physicians and staff averaged from 1-15 hours per WEEK processing the metrics data for submission to the Federal Government.  The conclusion is that the current system is unnecessarily costly (for physicians and staff) and that greater effort is needed to standardize measure and make reporting of measures easier.  A physician that has opted out as a Medicare provider is not required to submit this information.

The premise of value based payments is that physician groups will be reward for providing quality care.  The problem is that the metrics currently in use make the chance of penalized is nearly 40 %, the chance of unchanged payments is 59 %, and only 1 % of physician groups will be deemed quality providers which will make the group eligible for a few percent increase in payment from Medicare.
The numbers are an eye opener - 13, 813 groups participated, only 128 groups qualified for a bonus, and 5,477 groups will be financially penalized.  Hardly seems worth it to me to participate in programs like this.

Who in America would seek employment at a company where you chance for a
bonus or a raise is 1 %.  Who wants to be a physician in the U.S. today?

Friday, May 27, 2016

Preventing Common Summertime Injuries

Lawnmowers - wear closed toe shoes, keep young kids a safe distance away while mowing.  Most common injuries are foot lacerations, hand lacerations, and loss of toes and fingers.

Climbing ladders is likely the most dangerous thing you do- wear lace up shoes and do not go above the marked safety level  -  Common injuries include ankle fractures, foot fractures, and sometimes hip fractures.

Bike Riders are fragile, even when you are in the right - Use you light on summer nights, wear a helmet and drivers, please yield 3 feet to a bicyclist.  And slow down in the neighborhoods - lots of kids are on bikes in the summer - head injuries, wrist fractures, clavicle fractures and rib injuries happen a lot.

And our new favorite - Distracted Walking- texting or impaired hearing from loud earbud sounds impair your visual and hearing senses - Bad injuries occur when people walk into cars or off the road/sidewalk/hiking trail/escalators/parking lots.

Have a fun summer and be safe.