Cutting the

Red Tape
BY KATHRYN PIRIE
PUBA 672
DECEMBER 10, 2019
Three Main Points:

 Our system is complicated, but there are ways to ensure good patient outcomes if you
understand the system
 The concept of prior authorizations primarily helps insurance companies. It shifts the
burden onto providers and delays patient care.
 More rules and regulations are not going to curb healthcare costs. We need a true
overhaul of our system.
Jason Gizzi
 Background in business/finance
 Worked at small hospital
 Controller at larger hospital
 Back to small hospital
 Director of Patient Finances at large Health
System
 Background gives him clinical perspective
 Tries to navigate finance, clinical and
administrative
 Works in managing revenue cycle: pre-
authorization, d/c planning
 Needs to cut the red tape
The illogical continuum

Greater control and complexity 

Greater administrative costs 
Greater potential for cost containment
Another Way?

   Greater control and complexity   

   Greater administrative costs   
   Less Costs!!   
Initiatives to decrease paperwork

 2011 Executive order

 Affordable Care Act
 2017 Executive order
 “Patients over paperwork”
The Revenue Cycle
Prior authorization

Hours spent weekly

45
40
35
30
25
20
15
10
5
0
Physicians Administrative Nurses
Stafff

Prior Auth Everything Else

What can be done?

 Single Payer
 Electronic recording
 Gold card status
 Random authorizations/audits
 One month’s supply
What can you do?

 Streamline
 Guidelines and forms
 Accountability
Three Main Points:

 Our system is complicated, but there are ways to ensure good patient outcomes if you
understand the system
 The concept of prior authorizations primarily helps insurance companies. It shifts the
burden onto providers and delays patient care.
 More rules and regulations are not going to curb healthcare costs. We need a true
overhaul of our system.
References

 Behrendsen, J. (2017). A brief history of how we got to electronic prior authorizations. Cover My
Meds. Retrieved at: https://www.covermymeds.com/main/insights/articles/a-brief-history-of-how-
we-got-to-electronic-prior-authorization/.
 Brady, M. (2019) New CMS rules cut red tape, mandate discharge planning. Modern Healthcare.
Retrieved from: https://www.modernhealthcare.com/operations/new-cms-rules-cut-red-tape-
mandate-discharge-planning.
 Lawrence P. Casalino, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, Theodore
Karrison, Wendy Levinson (May 2009). What Does It Cost Physician Practices To Interact With
Health Insurance Plans? (Report). Health Affairs.
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.4.w533.
 Patients over Paperwork (2019).https://www.cms.gov/About-CMS/Story-Page/Patients-Over-
Paperwork-fact-sheet.pdf.
References

 The White House. Office of Press Secretary (2012). White House Announces New Steps to Cut Red
Tape, Eliminate Unnecessary Regulations. Retrieved from: https://obamawhitehouse.archives.gov/the-
press-office/2012/05/10/white-house-announces-new-steps-cut-red-tape-eliminate-unnecessary-regul.
 Twiddy, D. (2016). Beating the Prior Authorization Blues. Family Practice Management. 23(5):15-19.
 Wegner, S.E., Trygtad, T.K., Dobson, A., Lawrence, W.W., Steiner, B.D. (2009). A Physcion-Friendly
Alternative to prior Authorizations for Prescription drugs. The American Journal of Manager Care. 15
(12). Retrieved from: https://www.ajmc.com/journals/issue/2009/2009-12-vol15-
n12/ajmc_decwegnerwbx_e115finl.
 Zhang, Y., Adams, A, Ross-Degnan, D., Zhang, F.; Soumerai, S., (2009). Effects of Prior
Authorization on Medication Discontinuation among Medicaid Beneficiaries with Bipolar Disorder.
Psychiatric Services. 60 (4) 520-527. Doi: https://doi.org/10.1176/ps.2009.60.4.520