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'Unjustified and unnecessary': 3 surgeons on prior authorization rules in spine

By Admin | April 21, 2021

Prior authorization is a contentious issue in spine care at the moment. Beginning July 1, CMS will require the policy for cervical fusion with disc removal and implanted spinal neurostimulators, which physicians say will further limit access to care.

Three spine surgeons expand on how increased prior authorization policies will affect spine care:

Note: Responses are lightly edited for style and clarity.

Question: How will increased prior authorization regulations affect spine care?

Lali Sekhon, MD, PhD. Nevada Neurosurgery (Reno): Prior authorization is a tool used by payers to ration healthcare and improve their quarterly balance sheets. I have worked in a world (Australia) where there was no prior authorization and decisions were left to the treating physician. It works. The American system enables profits for payers by using gatekeeper functions beyond treating physicians. The proposed prior authorization changes are meant to streamline decisions up to 72 hours, provide rationale for denials and improve transparency through providing metrics. This is good. The appeals processes, often needing submissions in writing, using 'peers' who are often not in the same specialty, or practicing and using nepotistic guidelines, also needs overhauling. The payers will not likely loosen much control but...(More)

For more info please read, 'Unjustified and unnecessary': 3 surgeons on prior authorization rules in spine, by Becker's Spine Review

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