Administrative Hurdles Place Heavy Strain on Small Medical Practices
WASHINGTON – Today, the House Committee on Small Business heard from physicians about the administrative hurdles faced by small medical practices.
“Methods such as prior authorization and step therapy were introduced to reduce unnecessary procedures, prevent overprescription of dangerously addictive drugs, and reduce human error,” said Ranking Member Steve Chabot (R-OH). “However, despite the rationale for these processes, more must be done to streamline communication between practices and insurance providers. Many small medical practices struggle to afford necessary staff to complete the almost 60 extra hours spent per week on administrative tasks.”
Physicians Stress Need for Streamlined Process
“In a 2017 Medical Group Management Association survey, almost half of the group practices cited administrative burdens costing their practices more than $40,000 per full-time physician per year to fulfill the requirements of federal regulations… On average, dermatologists dedicate eight hours per week solely to administrative activity; precious time they could be otherwise dedicating to patient care,” said Dr. Howard Rogers, PhD, FAAD, Owner, Advanced Dermatology, LLC, in Norwich, CT. Dr. Rogers testified on behalf of the American Academy of Dermatology Association. “Preserving the treatment value between physicians and their patients should remain paramount; therefore, prior authorization and associated appeals policies should not encroach on or unduly burden physicians or patients in accessing optimal, medically necessary drug therapies.”
“Like all businesses, radiation oncology practices need to meet their regular financial obligations to keep their doors open, which is why the increasingly restrictive coverage policies and benefit managers’ “denial-by-delay” tactics must be addressed to protect patient access to life-saving cancer care,” said Dr. Paul M. Harari, Professor and Chairman, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, in Madison, WI. Dr. Harari testified on behalf of the American Society for Radiation Oncology.
“Practicing at Northwestern, I am fortunate that prior authorization burdens do not financially bankrupt us. However, I recognize that it can be very costly,” said Dr. David R. Walega, MSCI, Associate Professor of Anesthesiology; Chief, Division of Pain Management; and Vice Chair of Research, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, in Chicago, IL. Dr. Walega testified on behalf of the American Society of Anesthesiologists. “In one year, my practice dedicated over $80,000 in resources for prior authorizations. If the same costs and circumstances were incurred in a small group medical practice, it could be financially devastating to have overhead costs rise so high.”
“Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. They deliver care in more than 90 percent of U.S. counties – in frontier, rural, suburban and urban areas. Our members practice in a variety of professional arrangements, including privately owned solo practices as well as large multi-specialty integrated systems and public health agencies,” said Dr. John S. Cullen, FAAFP, Family Physician & Partner, Valdez Medical Clinic, LLC, in Valdez, AK. Dr. Cullen testified on behalf of the American Academy of Family Physicians.