PRIOR INSURANCE AUTHORIZATIONS - ANOTHER OBSTACLE IN PROVIDING PATIENT CARE

Over 1 in 4 physicians say prior authorizations lead to serious adverse events, AMA survey finds

Fierce Healthcare (2/6, Finnegan) reports, “In a survey (pdf) by the American Medical Association” conducted online in December, “28% of 1,000 responding physicians said the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening adverse events for patients.” Physicians were specifically asked “if the prior authorization process ever affected care delivery and led to a serious adverse event, such as a death, hospitalization, disability or permanent bodily damage or other life-threatening event for a patient in their care.” In an announcement that released the result of the survey, AMA Chair Jack Resneck, Jr., M.D., said, “The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care.” Dr. Resneck added, “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality healthcare they need.”

ANAPLASTIC LARGE CELL LYMPHOMA

FDA issues 2019 update on BIA-ALCL

The American Society of Plastic Surgeons (ASPS)  would like to make members aware of a Feb. 6  statement by the Food and Drug  Administration (FDA)  updating the number of adverse event  reports submitted to the agency related to  breast implant-associated anaplastic  large cell lymphoma (BIA-ALCL). The statement notes that as of September 2018,  the agency has received 660 total medical  device reports (MDR) regarding BIA-ALCL  cases in the United States – an increase of  246 new MDRs (59 percent) from the  previous year’s update. Acknowledging  that the nature of the MAUDE database’s  reporting system is susceptible to duplicate  reports, the agency’s analysis suggests  there are only 457 unique cases,  including nine deaths, of BIA-ALCL  reported (since 2010). The FDA  also notes that while the MDR  system is a valuable source of information,  it is a passive surveillance system with  limitations, including incomplete,  inaccurate, untimely, unverified or  biased data in the reports. The  incidence or prevalence of BIA-ALCL  cannot be determined from this reporting  system alone, due to potential under- reporting, duplicate reporting and lack  of information about the total number  of breast implants.

The FDA update calls  for no changes in recommendations  regarding breast implants.  For patients with breast implants,  the FDA states there is no need to  change routine medical care and  follow-up, and there is no need to  test asymptomatic patients. BIA-ALCL is a rare condition that occurs  most frequently in patients who have  breast implants with textured surfaces.  Patients should discuss with their  health-care provider the benefits  and risks of textured-surface  versus smooth-surface implants. .