By Dr. Stan Flemming
For the Reporter

You didn’t fill out the right form.

As a doctor, that one phrase can mean the difference between providing the treatment a patient needs or experiencing an unnecessary delay in care – care that can make a difference in the lives and health of those we care for.

As a physician, I am constantly working to keep up with the latest treatments, the newest breakthroughs and the best ways to treat people with whom I have a personal relationship. Unfortunately, the greater challenge these days is navigating the maze of paperwork used by health insurers – private and public – that often limits access to those treatments and increases costs to the healthcare system.

Known in the healthcare world as “prior authorization,” health insurers require physicians to get approval before they can prescribe treatments covered by insurance. With multiple forms per insurance company, simply navigating the paperwork often delays treatment and threatens the health and safety of patients.

Fortunately, there is an opportunity to make a change. In Olympia, the legislature is considering Senate Bill 5267 – a law that can streamline the paperwork required by insurance companies. Rather than having dozens of forms to complete before obtaining approval from the health plan, the number would be limited to a few standardized forms for all plans. This simple change would allow health insurers to maintain the ability to control costs, but would minimize the administrative burden on doctors’ offices and pharmacies.

Simplifying the approval process will contribute to improving the quality of care. There can be legitimate debates over which treatments are effective and if there are other less-expensive treatments that produce the same outcomes. The options should be considered when developing a plan of action for a patient. Creating a complex web of paperwork, however, makes it more difficult for the doctor and insurer to enter into that discussion.

It might make sense for private insurers (or government health programs, for that matter) to ask doctors to try a different treatment regimen based on sound medical reasoning. It doesn’t make sense, however, to demand alternative courses of treatment based simply on the fact that the wrong form was filled out, or the health plan does not want to pay for such a treatment.

More often than not, it’s the patient who is caught in the middle and who suffers needlessly while doctors and insurers haggle over process. In an age where electronic medical records are improving efficiency and reducing errors, the use of multiple forms for “prior authorization” is simply an outdated approach to ensuring quality care.

At a time where doctors and hospitals are more accountable for the outcomes of care, excessive bureaucracy should not be the one thing preventing patients from receiving timely treatment. Such tactics employed by health plans contribute significantly to the cost of providing care. The excessive back and forth between health plans and physicians’ offices caused when the incorrect form was used or a minor piece of information was accidentally left off the form will, in most cases, generate an entirely new form that must also be processed.

Health plans use these tactics to delay care or to have the request withdrawn due to patient or physician frustration. Other factors that drive the cost of care is the additional staffing required in the doctor’s office who are dedicated to addressing such issues full-time.

Limited healthcare dollars should be designated for making people healthy, not navigating the rules. Encourage your legislator to pass SB 5267 to help lower health care costs and improve patient access to care.

Seattle-area resident Dr. Stan Flemming, DO, MA, is a board certified family medicine physician with more than 20 years experience in healthcare. He is an authority in the area medical information processing.