Newly Released Study Shows Insurance Barriers Blocking Access to Healthcare

/PRNewswire/ -- Significant barriers to patient care implemented by the health insurance industry are difficult to navigate, have a negative impact on patient care and drive up the administrative costs of healthcare, according to a statewide survey of Georgia physician assistants. The survey, which was released today by the Georgia Association of Physician Assistants (GAPA), also indicated that most physician assistants (PAs) are proactively taking steps to help address the problems that plague the system, and feel there is a legislative role that can contribute to a solution.

According to the survey, a nearly universal 99 percent of PAs stated they have had to change the way they treat a patient as a result of restrictions imposed by an insurance company. An overwhelming majority, 94 percent, feels that health plans frequently or occasionally delay or deny diagnostic testing or prescription medications for their patients.

Not surprisingly, 93 percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.

"The lessons learned from this report are resounding, in that nearly all the physician assistants that responded to the survey cited major insurance hurdles they had to jump over before being able to provide the care they deemed appropriate for their patients," said Mary Vacala, ATC, PA-C, MSPAS, DFAAPA, and 2010-11 president of the Georgia Association of Physician Assistants. "Some cited several phone calls taking 45 minutes with an insurance company. Others noted that patients are forced to go without medication until the insurance company would approve the treatment already prescribed by the healthcare professional."

One-in-five respondents stated they or their staffs are required to interact with an insurance provider to obtain approval for a prescribed course of treatment or to determine the insurer criteria for prior authorization or step therapy protocols an alarming 150 times or more per month. Approximately one-in-five said the number was 61-100 and more than one-in-four stated the number of interactions as 21-60.

Understanding that each hour a provider spends on administrative tasks is an hour not spent evaluating patients, PAs are proactively taking steps such as utilizing newer technology to streamline the process. Currently, 64 percent of respondents have implemented Electronic Medical Records and 45 percent are using an e-prescription process on some level. At the same time, 90 percent of those surveyed agree that there should be enforceable legislation addressing restrictions that insurance companies place on health care providers.

"There are more than 2,000 physician assistants across the state of Georgia, and so many are using technology such as electronic medical records and e-prescribing, to promote better, more coordinated care," concluded Vacala. "As these technologies continue to be developed, the Georgia General Assembly should take steps requiring that patient formulary information be more transparent and that there be a uniform electronic process for obtaining medication approval. By taking simple steps, we will save significant time and resources while also having a healthier patient population in Georgia."

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Guidance on New Hospice Benefits for Terminally Ill Children Hailed by Hospice and Palliative Care Community

/PRNewswire/ -- The families of dying children who are covered under Medicaid or the Medicaid expansion Children's Health Insurance Program (CHIP) will no longer face the choice of stopping curative treatments in order for their terminally ill child to receive quality end-of-life care from hospice.

The provision in The Patient Protection and Affordable Care Act requiring state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatments has been widely applauded by the hospice and palliative care community. In an important step to implement the law, the Centers for Medicare and Medicaid Services issued a letter of guidance on Thursday, September 9, 2010.

"This provision is a very important step forward for children with life-threatening illness. No longer will families need to make an agonizing choice to give up cure-directed treatment in order to receive the multiple benefits offered through a comprehensive hospice program," said Sarah Friebert, MD, Director of the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital.

J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, remarked, "NHPCO has been a longtime advocate for the provision, previously working with Senators Jay Rockefeller (D-WV)and Susan Collins (R-ME) to include the language in their Advance Planning and Compassionate Care Act."

Throughout the various stages of health care reform deliberations, NHPCO went on record as supporting the inclusion of the pediatric concurrent care provision and actively lobbied for its continued inclusion in the final version of the legislation.

The law does not change the criteria for receiving hospice services. In order to qualify for the hospice service in either Medicaid or CHIP, a physician must certify that the eligible person is within the last six months of life.

In the letter issued by CMS, Cindy Mann, federal Medicaid Director, wrote, "We believe implementation of this new provision is vitally important for children and their families seeking a blended package of curative and palliative services. This provision will increase utilization of hospice services since parents and children will no longer be required to forego curative treatment."

"Care for children and families facing serious illness and death are an important population that should not be overlooked," noted Schumacher. "This law is the right thing to do for families facing the tragedy of a dying child."

Friebert further added, "We have further work to do to secure reimbursement for services for children with chronic, complex and/or life-threatening illness who do not qualify for hospice, and need the same protection to receive concurrent palliative care and cure-directed therapy."

To further support the care of young people with serious and life-limiting illness, NHPCO and the Children's Project for Palliative/Hospice Services (ChiPPS) developed and published The Standards of Practice for Pediatric Palliative Care and Hospice and released a report "Facts and Figures on Pediatric Palliative Care and Hospice." Additionally, the first module of a series of ten online courses on pediatric palliative care was launched on NHPCO's web-based E-Online education portal.

Learn more about the Pediatric Standards, ChiPPS, or download the facts and figures report at www.nhpco.org/pediatrics.

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