Issue link: https://beckershealthcare.uberflip.com/i/1504986
23 GASTROENTEROLOGY Certainly not without any reasonable amount of time to analyze and assess that information. We did ask again repeatedly. ey basically said, "We are going to go ahead with something on June 1," and yesterday they did publicize this advance notice program. As far as I can tell, there is still no information in the materials that have been sent about how this operationally works. Another theme in our interactions with United is they don't provide data. United keeps speaking to overutilization of endoscopy services, and we pressed them on the call specifically about that and how they know there's overutilization. Ultimately, what they admitted was they don't have any information to support it. ere have been studies which look at geographic variation in services, but UHC has nothing other than claims data. ey are trying to get information, and I think that's the ulterior motive of doing this advanced notification process. It is getting information out of physicians medical records that's not readily available right now on an easy basis. ey themselves have no data they're willing to share with us, and they don't have any such data supporting overutilization. Q: Why do you think UHC pulled back on the proposed prior authorization changes at the last second? LK: I can't speak for them. I don't know why they made the change and I don't know if it's actually a change. From my practice's point of view, I don't see a difference. Mostly because all prior authorizations do get approved. e frequency of denials, I don't have official data, but anecdotally, I can count on one hand the number of times I have gotten turned down in 25 years of practice. By and large, gastroenterologists do the right thing. ere's guidelines we follow. Sometimes there are patients that guidelines are not directly applicable to, and we make the right decisions on how to address those patients. Q: What is this advanced notification process going to be like for physicians? LK: e advanced notification process is going to be difficult and onerous to comply with. For every single procedure that we do, except for screening colonoscopies, somebody on our staff is going to have to abstract clinical information from our electronic health records and provide that to United. at is going to be a significant volume of patients. United is one of the largest payers in most markets, and gastroenterology is a high volume specialty. Most GIs do many procedures in a day. To put it into perspective, each physician at our practice does about 1,100 procedures annually, and 25 percent are United patients. If you try to think about what UHC is trying to achieve here, they are trying to get information from medical records, which will not be contained in a discreet coding scenario. Codes generally don't have clinical detail, which is something UHC says they don't have. at's the problem with medical records in general. With the absence of any structured way to get that information, it's reading through medical records to get that information. Healthcare researchers spend their whole career trying to do this. Now, we're going to be putting this onus on physicians and staff to do this. Is a physician going to do this? ere aren't enough hours in the day for that to happen. Can practices afford to get nurses or clinical staff to do it? Probably most can't. is is going to fall on clerical people and there's going to be a lot of mistakes. is data will be highly inaccurate. It's not going to answer the questions United is trying to answer. ere was an opportunity lost here for UHC to work constructively with the major GI societies to figure out variation in practice and why that's occurring and to educate and solve a problem in a constructive faction. Which is why societies like AGA exist. Instead, what you're going to have is an onerous process that is still going to delay care to patients and still present barriers to care. What I'm concerned about is underutilization. UHC speaks to this a little bit in the bulletin they sent out, that they will see if there's underutilization. I'm not sure how they are going to tell that. Q: How will it impact patients, if at all? LK: I don't know. It hasn't actually been implemented yet, but what I do know is once it is in place, some person on my staff is going to have to try to figure out how to enter all this information before scheduling a procedure. Trying to go through that process for the number of patients we see in a day is going to take a significant amount of time and effort on behalf of the practice. For practices that do not participate, you don't get a shot at being a "United gold card member," but they haven't laid out what that means. at's the carrot UHC is dangling. If you somehow demonstrate that you are an acceptable provider, by their criterion, we will let you into this gold card program. But there's no real information about how you're going to be eligible for that, or what that even means. What we do know is they're not abandoning prior authorization, they're simply postponing it. Which flies in the face of everything they've been saying. ey've been talking publicly about how they are moving away from prior authorization. With GI, this is going to be a major expansion of prior authorization, which we basically know just doesn't work. It delays care, harms outcomes and endangers patients in many situations. n Medtronic to discontinue GI SmartPill after 17 years By Claire Wallace M edtronic plans to discontinue its SmartPill, a wireless ingestible capsule that monitors pH, transit time and temperature in the digestive tract, following 17 years on the market, according to a June 22 report from Medscape. The company has not specified when it will leave the market, but it is likely due to a business decision, not a safety issue, according to the report. Braden Kuo, MD, a gastroenterologist in Boston who took part in the SmartPill's development, said that the discontinuation is causing concern among his colleagues as there is no other analogous FDA-approved device on the market. Dr. Kuo said that thousands of SmartPills are used in GI clinics every year, and they are commonly covered by insurance. The SmartPill was originally cleared by the FDA in 2006. Six years later, it was sold to Given Imaging, which was acquired by Medtronic in 2015. n