October 25, 2008
There's nothing like hearing the results of studies directly from those who actually conducted the research. In this interview, you'll meet one of these impressive HIV researchers and read his explanation of the study he presented at ICAAC/IDSA 2008.
My name is James Willig. I'm an assistant professor at the University of Alabama at Birmingham. I'm part of the team from the 1917 Clinic headed by James Raper: Michael Mugavero, Michael Saag and Jerome Allison all helped in doing this project titled "The Hidden Costs of Prior Authorization: Uncompensated Effort for Medical Providers."1
James Willig, M.D.
Insurers ask us to fill out prior authorizations to get access for patients with certain medications. Dr. Raper, our clinic director, centralized this process a few years ago and he committed to doing every single prior authorization for every patient in the clinic in addition to all of his regular responsibilities.
He quantified all the time that it took him, all the clerk time that it took and the notification time before he heard back from the insurers, and we calculated the estimated cost for having to do this for every patient.
There are a lot of good data showing that having providers doing prior authorizations saves money at the insurer level, but I think there's very little information out there talking about how this affects clinics and people that are in the front line of taking care of patients. These numbers, I think, give us a little glimpse of what that turns out to be.
Could you go through the numbers?
I think one of the most important things here is that prior authorizations introduce a mean 3.1 plus or minus 5.8 day delay to medication access. In our patients, it might take as long as nine days before they get access to the medication that was required. If that's an antiretroviral, it means they have to have a week without medications. If that's a lipid medicine or some other type of medicine, that's a week before you can get the needed medication delivered to the patient.
Prior authorization requests take at least 26.8 plus or minus 18.5 minutes of time out of that centralized provider. Dr. Raper has done these for two years. He's quite good at that, and it still takes him about a half hour, plus an additional 6.5 minutes from a clerk who helps with the final steps.
In total, we're talking about 30 minutes of time for every single one of those requests to get completed at the clinic. This is time in which we could be taking care of patients. This is time in which we could be doing a lot of other responsibilities that would help folks on a day-to-day basis.
What do you hope to do with this study?
We're working on the manuscript. I think that this study sheds light on the issue from a different perspective. It's great that this is a cost-containment strategy for health care organizations, but I think we need to be honest here and see that there's a little bit of cost-shifting going on. By moving this to the providers, it takes time away from what we do, it's unremunerated time, and it ultimately comes back to haunt our patients by delaying when they can get their medications delivered to them.
Is there anything that could quickly happen to change the situation or is this a very long-term effort?
I think this is a long-term effort. I think we need to get this information out there to policymakers and folks who need to see this. A lot of clinics that are taking care of HIV-infected folks have some issues with funding. Funding has been flat for a while with Ryan White CARE Act funding. Patient numbers continue to grow nationwide. Estimates have been revised in terms of how many people out there have HIV in the U.S. by the CDC [U.S. Centers for Disease Control and Prevention] recently.2
We see that with routine testing now, there's an expected increase in the numbers of patients coming in. As all of these things happen, costs are really going to go up. Prior authorizations, I think, are going to be used increasingly as a cost-containment strategy. I think we need to acknowledge what this does at the clinic level. Policymakers need to put this into the thinking, so that we have more support for patients at that level.
Thank you very much.
This transcript has been lightly edited for clarity.