Issue link: https://beckershealthcare.uberflip.com/i/1504986
22 GASTROENTEROLOGY UnitedHealthcare's 'ulterior motive' to new advanced notification process By Claire Wallace O n May 31, UnitedHealthcare reversed the proposed June 1 implementation of a controversial prior authorization process that would require gastroenterologists to submit requests for certain endoscopy procedures. Instead, it implemented an advanced notification process that requires practices to submit certain patient data leading up to procedures. Practices that follow directives will have the opportunity to join a UHC "gold card" program in 2024. ree major gastroenterological societies — the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy — have opposed UHC's prior authorization plans since they were released in March and were disappointed about the lack of communication from UHC. In May, UHC gave the major societies less than 24 hours of notice to discuss the alternative advanced notification process, asking for public support from the societies. Lawrence Kim, MD, vice president of the AGA and gastroenterologist at South Denver Gastroenterology in Littleton, Colo., spoke with Becker's about the new advanced notification process and the difficulty of working with UHC throughout the proposed reform. Question: Give us some background on how everything with UHC occurred. Dr. Lawrence Kim: I was part of the call last Friday with UHC. e proposed prior authorization change has been in the works for months. AGA has been in constant communication with UHC asking them for more information, their rationale for institution, expressing concerns with regard to delaying patient care, potentially compromising health outcomes, especially in terms of worsening disparities, and of course the practice burden on physicians. is has been in the works for several months. UHC, by and large, has been completely unresponsive. Last ursday, there was a very hasty invite to a call that was going to occur in 24 hours, which obviously was fairly difficult. We were able to pull together leadership from the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy to hear what they had to say. It was interesting to me. I am a little bit incredulous because they basically said we are going to rescind prior authorization plans, and instead are going to substitute this advanced notification program. ey started the call by saying, "We're going to do this and we would love for the GI societies to publicly support the change." is was done with no warning, no information, nothing that was sent to anybody on the call or in advance of the call to even know what they were talking about. When we asked for details about what that involves, it was very nebulous. ere was no clear process. ey alluded to a portal that practices would have to log onto to supply clinical information about each case that was to be scheduled. at was about it actually. at's all they told us despite repeated efforts to pull more information about what the portal is and what types of information will be required. ey kept referring us back to their existing prior authorization policies. ey said something about 50 percent of prior authorization decisions are made through the patient portal online. e others go to peer-to-peer, where you have to wait for one of their representatives to contact you. at was kind of the gist of the call. Our response was, "We can't support a policy or program that we have no details about."' Image Credit: thestreet