Why PAs?

[Guest guest]

Please send one green at your earliest convenience.Of course, many prior authorizations are a ridiculous waste of time and energy, but I am an advocate of rational PAs. Too many doctors wantonly order inappropriate tests and medications. Physicians bias toward errors of commission and fear of making errors of omission leading to malpractice suits, is part of the reason that Americans pay a higher percentage of our gross domestic product than any nation yet we lag in quality measures across the board.Choosing Wisely is an effort of nine medical societies representing 375,000 physicians to encourage physicians to be better stewards of finite health care resources. In order

to improve care we need to eliminate unnecessary tests and procedures. Too often well meaning doctors order tests that do not improve outcomes. A few examples:a) Early imaging for back pain, which would resolve in a few weeks. CT or MRI in patients with syncope and normal neurological exams.c) Pre-operative chest x-rays in patients without clinical suspicion of pathology.A member of a local Pharmacy and Therapeutics Committee of Neighborhood Health Plan of Rhode Island, I am proud of a recent action. Two years ago we altered our Suboxone PA prohibiting off label use- some physicians were ordering it to treat pain. Over the past year NHPRI providers requested PAs for Suboxone more than any other medication. Our review showed that all PAs were approved. Our solution? We eliminated the prior authorization, thus saving valuable physician and pharmacist time and energy.Any limitation of physician prerogative needs

be rational. In the zero sum game of American Medicine, physicians practice will be subjected to constraints as long as many physicians fail to adhere to best practices based on sound science.