As prior authorizations continue to burden physicians and patients alike, UnitedHealthcare is billing its gold-card program as a way to alleviate care delays and save physicians time.
Under the program, practices that stick to evidence-based guidelines will be able bypass prior authorizations for some cases, with more information about the program coming out on Sept. 1.
While some spine surgeons are skeptical about the gold card, others are optimistic about its potential.
Nolan Wessell, MD, an orthopedic surgeon and assistant professor in the department of orthopedic surgery at the University of Colorado School of Medicine in Aurora, spoke with Becker's about the burden of prior authorizations and the way some groups are advocating to eliminate barriers to care.
Dr. Nolan Wessell: I've spent a fair bit of time working on a variety of prior authorization projects within my own institution, but also at the state level as a board member for the Colorado Orthopedic Society. The UCH gold card program, if executed fairly, has the potential to be beneficial for both patients and providers. Currently, delays in prior authorization lead to significant delays for patients as they await surgery, which leads to potential clinical harm, dissatisfied patients and inefficient use of surgeon's time, adding to costs within the healthcare system as a whole. The American Medical Association estimates that $1.3 billion was spent on administrative costs related to prior authorization last year.
Something needs to change, as we cannot continue with the current system. While hospital margins continue to dwindle, UCH posted $22 billion in profit for 2023. This might be good for investors, but it's bad for patients, bad for providers and bad for America. I wish I could trust our political leaders to do the right thing and pass meaningful legislative reform, but the onus will likely continue to fall on providers to advocate effectively for their patients and the betterment of the American healthcare system.