Patients and Physicians Speak Out

I am a pain management specialist, so nearly every one of my patients is on high-dose opioids. Nearly every single script I write requires prior authorization - even for what I would consider "reasonable" levels of chronic opioids (based on the patients I see, at least- NOT on what a PCP might encounter). Clearly, some of the problem is from the overly restrictive policies that have superseded physician judgment with "protocols and guidelines." Those protocols and guidelines have been created to address 90-95% of the patients that are seen in the normal course of routine practice.... yet nearly EVERY one of "my" patients falls into the 5-10% range of patients that are "outliers" due to their need for high-dose opioids.... which is the whole reason that they were referred to me in the first place.

For patients on high-dose opioids, having to wait for a prior authorization or a "discussion” ("fight") with a pharmacist, can risk putting them into acute opioid withdrawal. However, it also means that I routinely have to spend 30-60 minutes "above and beyond" the actual time spent with the patient and time spent charting. My only recourse is to now document all of that time in detail and "code accordingly," meaning that I am trying to get reimbursed for the additional time spent doing these prior authorizations. Although this is costing the insurance company a marginally increased amount of money, the amount generally does not adequately compensate me for my time and frustration. It greatly increases the patients' anxiety, as well. For "specialists," there really should be no excuse to demand additional paperwork [that] appears to be nothing but perfunctory.

I have no admin back-up. All prior authorizations are done by me. As a psychiatrist, I book my schedule as tightly as possible, so these extra phone calls, being on "perma-hold" for 10-25 minutes, takes a big bite out of my time. Not to mention that they often are on the mainland, and there is a 2-3 hour difference in time zones between Hawaii and California. Not to mention the 5-6 hour difference to the East Coast, so it's hard to do this at the end of the day for me. A colossal waste of my time, a never-ending source of frustration, and frankly, another thing to push me towards retirement, and I know that there is still a shortage of private psychiatrists in my state.