aAfter weeks of protest from physician organizations and patients, UnitedHealthcare has suspended a controversial new prior authorization policy for gastroenterology procedures. The policy, which requires doctors and patients to get approval from the insurance giant for nearly all gastroenterology procedures, including diagnostic and surveillance colonoscopy, or possibly pay out of pocket, would have gone into effect June 1.
Instead, the company has a different policy it calls “advanced notice,” which requires doctors to let United know they will be performing certain gastrointestinal procedures and provide information such as why it’s needed and the patient’s medical history. “This advance notice will not result in denial of care for clinical reasons or for failure to report,” a UnitedHealthcare spokesperson told STAT in an email.
Still, the frustration of gastroenterology associations and the public outcry following STAT’s reporting of the problem have not completely abated. That’s partly because the advance notice will still burden physician offices and because the program still feels involuntary, said Barbara Jung, the president of the American Gastroenterology Association. Physicians who fail to provide the pre-notification are disqualified from United’s “gold card” program, a status that allows physicians to bypass all pre-authorizations.
“It was disappointing,” Jung said. “It’s different from prior authorization because there won’t be any denials as part of this, but we don’t have a lot of details.”
At a meeting the physician groups had with United last week, Jung said gastroenterologists had again asked United for data on overuse and non-compliance with clinical guidelines. “It became clear that they didn’t have such data,” Jung said. “And this pre-notification was launched and it became clear that it is a data collection tool. This is really to help inform a future pre-authorisation proposal, so it appears to be a pre-authorisation pre-rollout.”
A statement from United confirmed that the pre-notification program is designed to collect data, though United said it was to better understand which doctors qualify for the “gold card” program.
The move from pre-authorization to pre-notification is a step in the right direction, said Molly Smith, vice president of public policy at the American Hospitals Association. “We certainly had concerns about prior authorization for certain GI procedures. Prior authorization has been shown to create barriers to care,” said Smith. “We are very happy with the step United is taking with the program.”
That’s because advanced reporting shouldn’t create new barriers for patients getting lifesaving procedures, such as colonoscopies and other GI procedures, nor should it prevent doctors from getting paid, Smith said. She is also hopeful that the gold carding program will alleviate some of the administrative burden that pre-approval policies impose on physicians in general, although: “We have seen so far that it is difficult to to put. They need data and information to design,” Smith said.
Jung said that while collecting data may be a step in the right direction, United’s pre-notification program is unlikely to yield useful data on the overuse of gastroenterology procedures. United has not provided doctors with a standardized way to provide the information they need, she said. Without a clear data collection and research plan, it can be difficult to compare information from one clinic to another – you may not know if you are comparing apples to apples.
“Our healthcare researchers were not confident that this kind of data collection could provide a meaningful database to answer their question — if that question is overuse,” Jung said.
United also did not indicate any plans to share data collected from the advance notice program with researchers or gastroenterology societies, Jung said.