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ACP-ASIM Pressroom

Internists Applaud UnitedHealth Decision to Eliminate Clinical Precertifications

November 12, 1999

Removal of preauthorizations puts decision-making back into the hands of physicians

(WASHINGTON, DC): The American College of Physicians—American Society of Internal Medicine applauds UnitedHealth's decision to reverse their preauthorization for services policy and give doctors—not administrators—the final say on necessary treatment of patients.

"The use of precertifications in managed care has proven to be a source of delay and red tape in the treatment of patients," said ACP-ASIM President Whitney Addington, MD, FACP. "This decision by the nation's second-largest health care insurance company to remove this barrier is a significant step in providing the best possible care to our patients."

While ACP-ASIM sees this move as a step in the right direction, members have been warned to monitor other measures the health plan may substitute in an effort to control costs that may interfere with patient care decisions. UnitedHealth has indicated that it may rely more on the practice of profiling physicians in their decisions of which providers to allow into the plan. Although ACP-ASIM believe there may be appropriate needs for profiling, it is essential that profiling not be used to drop physicians whose practice patterns may be classified as more expensive because they treat patients who are considered more ill.

"UnitedHeath's action in no way eliminate the need for Congress to enact productive patient's bill of rights legislation," said Addington. "Federal legislation is the only way to assure that doctors, not health plan administrators, make patient care decisions."

As is now common in managed care companies, UnitedHealth previously reviewed - with the option to overrule - doctors' treatment decisions. The company has admitted this widely practiced policy backfired, eventually costing them more than it saved. Such policies were originally deemed as necessary to manage costs in managed care settings. For physicians, however, they are an unnecessary barrier between their patients and good health as well as a source of time-consuming frustration.

UnitedHealth plans to still ask doctors to justify such decisions as ordering surgery or expensive diagnostic tests, but the company has stated that the doctor will have the final say on how the patient will be treated. The move is expected to be implemented nationwide next month.

A 1995 ACP-ASIM survey found that doctors believed the use of preauthorizations increased rather than decreased costs. Further, in 1998, the organization recommended managed care organizations to require preauthorizations only for services for a specified procedure if there is clear evidence that routine use of preauthorization substantially reduces the number of medically unnecessary services; and the costs of conducting the preauthorization do not exceed the potential savings.

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership comprises more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America and treat more Medicare patients than any other medical specialists.

Contacts

Jack E. Pope, ACP-ASIM Washington Office, 202-261-4556

Page updated: 11-04-03

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