Atlanta, Ga. (March 24, 2011) – Georgia physician assistant Ben Taylor, PA-C, PhD., addressed a national gathering of the Association of Family Practice Physician Assistants (AFPPA) today, concerning simplifying the administrative process in health care that often hinders patients from receiving the treatments they need.

Taylor was chosen to speak at the conference, held in Charleston, South Carolina, about the ongoing issues with health care saying, “Everyone agrees that health care continues to be a great debate – at the national and state level. Consensus on what is best for our country is hard to come by, but consensus on some very specific ‘details’ of health care delivery, such as access barriers and administrative issues, is not so controversial.”

Taylor, who is the senior PA at the Medical College of Georgia Emergency Room, and serves on the Boards of both the Georgia Association of Physician Assistants (GAPA) and AFPPA, cited a GAPA study that was released last week that showed:

Respondents indicated they had difficulty obtaining information from insurance companies as to which treatments would be covered for their patients. Forty-nine percent said there is rarely or never any transparency indicating which procedures or medications are available or which will require pre-approval. More than one-in-four stated such transparency exists only “sometimes.”

Ninety-three percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.

Ninety percent of those surveyed agree that there should be enforceable legislation to regulate restrictions that insurance companies place on health care providers in regards to treatment protocols such as prior authorizations for patient care.

As an example, Taylor told the story of one of his own patients who was denied medication by his insurance company and suffered significantly.

“My patient had uncontrolled hypertension and after trying medication after medication, I worked with his cardiologist and successfully controlled his hypertension with a specific medication,” he explained. “However, when he went to the pharmacy to fill the prescription, he was told that the medication needed a prior authorization from his insurance company and he would have to wait on the process. While waiting a week for the authorization, he suffered had a stroke, and was hospitalized for two months.

“For every story I have, each PA at this national meeting has more,” he stated. “But the heart of the issue remains the same: administrative burdens placed on us are impacting patient care and essentially, hurting all of us.”

Taylor explored his belief that Health Information Technology (HIT) – Electronic Medical Records, e-prescriptions and more – promises to positively impact patient care, and to preserve the provider/patient relationship. The Georgia General Assembly is expected to consider legislation over the next two years that would require insurance companies to be transparent and provide a patient’s pharmacy benefit information to the electronic platforms and implement electronic methods to attain prior authorizations.

“The GAPA survey found that 64 percent of the PAs are already utilizing Electronic Medical Records and 45 percent use e-prescriptions,” Taylor said. “As providers, we know this is only going to grow. If we are able to know what treatments required prior authorizations, we could handle them at the point of care, and not leave patients in a lurch at the pharmacy counter as in the case of my patient.”

Health Affairs estimates that savings could be $70,000 per year per primary care provider. Taylor noted that such legislation would be a “win” for everyone – patients and providers – and it would drastically cut down on the time and energy spent on the red tape.

It is the mission of the Georgia Association of Physician Assistants to promote high quality, cost-effective, accessible health care as part of a physician-directed PA/physician team in Georgia. For consumer health tips or to learn how PAs make health care more affordable and accessible in Georgia, please visit www.GAPA.net and click on “Patients.”

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