Medicare Managed Care?

Prior authorization is a common tool that managed care organizations use to reduce patient utilization of medical services. Some physicians believe that prior authorization creates barriers to effective care, but other commentators believe that prior authorizations can be implemented in a more efficient manner. Either way, prior authorizations are a form of rationing care.

Although Medicare typically has not required patients to seek prior authorizations to use specific services, this may be changing with the start of the Prior Authorization for Power Mobility Devices Demonstration.

More from Jason Shafrin at the Healthcare Economist.

Comments (5)

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  1. Joe S. says:

    Sounds ominous.

  2. Craig says:

    This may sound ominous to Joe S., however, when you understand that the states identified for this demonstration project are known bastions of gross fraud with respect to overutilization of powered vehicles, maybe you begin to get it. One also must consider that the use of a powered mobility device hardly classifies as “medical care” in the overwhelming majority of cases.

    If we can get anywhere close to ‘appropriate’ levels of utilization in this one area/device, literally billions can be saved.

  3. Brian says:

    Changes acomin’

  4. Virginia says:

    It’s amazing that Medicare hasn’t put anything like this in place before now. It’s a testament to the real budgetary problems that we face that Medicare is finally trying to implement some of these forms of rationing.

  5. Devon Herrick says:

    All scarce goods and services are rationed. I n Walmart, the price tag is a form of (price) rationing. But if goods are not rationed by the individual consumer, then goods musts be rationed by someone else. I may sound like a broken record, but if someone else is paying for care, they necessarily must use some sort of rationing technique. Prior authorization is a rather crude technique that allows Medicare to monitor various types of care that is administered on behalf of Medicare patients. This (presumably) helps prevent fraud or at least reduces unnecessary care.