Prior Authorizations – One More Reason To Be Angry At Health Insurance Companies?

by Heath Mackley, MD, FACRO

Don’t you get upset at health insurance companies?

To that frequently asked question, my short answer is, “No.”

I have no love for health insurance companies either, but the anger that physicians and patients feel about them should probably be more evenly distributed between the insurance companies, the healthcare providers, the lawyers, the government, and anyone that receives the benefits. Like most of our modern “messes,” it started with a mixture of theory, good intentions, self-interest, and lack of appreciation of the consequences of government policy decisions. From that point, it evolved in directions that reflected the competing interests of the parties involved. But this is not going to be a historical treatise about how we arrived at where we are, instead, it’s a description of where we are, so we can best move forward with our eyes open. read more…

Members in the News

C. Eve Jensen Kimball, MD, FAAP

C. Eve Jensen Kimball, MD, FAAP

“The American Academy of Pediatrics Section on Oral Health presents the 2016 Oral Health Service Award to C. Eve Jensen Kimball, MD, FAAP, for working to advance children’s oral health through education, medical/dental collaboration, and advocacy.” It was presented at the AAP National Conference & Exhibition Meeting in San Francisco, CA on 23 October 2016. This award is given to a member of the Section on Oral Health that has contributed significantly to the mission of the Section to improve children’s oral health and medical/dental collaboration.

Dr. Mele

It was recently announced that Dr. Aparna Mele is being honored by the Girl Scouts of Eastern Pennsylvania at their annual Take the Lead banquet being held on March 30, 2017. The honorees are positive role models for the girls of today, providing them with the courage, confidence and character necessary to make an impact on our community. Dr. Mele was selected for the impact the educational event she founded, “Guts and Glory,” has on our community. Anyone interested in attending the Take the Lead banquet, please call the BCMS office.

Penn State Health St. Joseph elevates Chris Newman, MD, to Chief Medical Officer Christopher Newman, MD, has been named the Chief Medical Officer of Penn State Health St. Joseph following the retirement of Gary Lattin, MD. In his role, Dr. Newman has primary accountability for clinical leadership and clinical quality and medical staff relations. He serves as the key administrative liaison to the employed and independent medical staffs. He also oversees physician governance and has a significant strategic responsibility for developing clinical integration strategies.

Dr. Newman joined Penn State Health St. Joseph as Associate Chief Medical Officer 18 months ago from Lehigh Valley Health Network’s Physician Group. Prior to joining Lehigh Valley, Dr. Newman was the President and a managing partner for Lehigh Area Medical Associates, a large, private internal medicine practice in Lehigh County.

Dr. Newman is a graduate of the University of Scranton, where he earned his bachelor’s degree in biology. He completed medical school at Georgetown University School of Medicine, Washington, DC, and his residency at Georgetown University Medical Center. In the spring of 2016, he received an MBA from the prestigious University of Virginia’s Darden School of Business.

DOH Launches Prescription Drug Monitoring Program to Combat Opioid Abuse – Here’s What You Need to Know

Pennsylvania physicians who are licensed, registered, or otherwise lawfully authorized to prescribe controlled substances, other drug or device in the course of professional practice, or research in this Commonwealth are required to register in the state’s new controlled substances monitoring program (PDMP).

Once you have registered, the system will be ready for query beginning Aug. 25, 2016, according to the Pennsylvania Department of Health (DOH). DOH’s PDMP webpage contains more information, including a link to register.

According to the law, once registered, prescribers shall query the system for each patient the first time the patient is prescribed a controlled substance by the prescriber for purposes of establishing a baseline and a thorough medical record. A prescriber shall also query the system if he or she believes or has reason to believe, using sound clinical judgment, that a patient may be abusing or diverting drugs.

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