Thomas Cha, MD, MBA, Massachusetts General Hospital (Boston): The administrative burden when dealing with third party payers is ever-increasing. The payers’ policies regarding the medical necessity of a treatment determine treatment options that physicians offer their patients. It’s tough to quantify the amount of time spent on the phone or filling out forms but the process is aggravating and requires time that could be better spent on more meaningful tasks. The challenge for orthopedic surgeons in 2015 will be for societies and surgeons to work on consensus clinical practice guidelines based on outcomes research, specifically cost effectiveness studies.
This has already been started, but the next step is to work with third party payers to align their policies with these guidelines. An example of this is the procedure order entry (PrOE) project we are participating with third party payers in Massachusetts to address the pre-approval process for lumbar spine surgery.
ProE is powered by QPID Health’s Q-Guide product. We’ve been using the tool for about a year and a half now and it has helped lessen the documentation burden significantly.