Prior Authorization 2021

The Illinois State Medical Society (ISMS) and a coalition of other healthcare organizations, including our DuPage County Medical Society, are supporting a campaign to pass the Prior Authorization Reform Act (HB 711/SB 177) in Springfield. 

The prior authorization cost management tool used by third-party payers regularly requires physicians to submit additional forms and documentation before their recommended patient care is approved for payment. The requirements delay needed care, sometimes preventing patients from accessing care at all. Physicians stress that increasing overuse and misuse of prior authorization by insurers is harming Illinois patients and placing heavy burdens on their care teams.

To assess the impact, ISMS surveyed Illinois physicians and healthcare institutions about their prior authorization experiences. The more than 1,000 responses received detailed a wide range of concerns and highlighted the urgent need for reform.

House Bill 711 and Senate Bill 177, the Prior Authorization Reform Act, will create a system to reduce long term health care costs by eliminating or reducing inefficiencies and by keeping people healthy on the front end. Among other provisions, the Act would establish deadlines for prior authorization decisions – 24 hours for urgent care services and 72 hours for nonurgent care.

Adding 'Gen Z' to the Differential Diagnosis

Adding 'Gen Z' to the Differential Diagnosis

Glen Ellyn's Andrew Tran, a DCMS student member at Tulane, and his younger sister, Kaitlyn Tran, share thoughts on generational difference in this Member Pulse. All views are those of the authors.

ANDREW: I was looking at an odd rash – or something that looked like a rash – during a virtual conference. The speaker displayed a peculiar, rhomboid plaque with central pallor and surrounding erythema. Even more unusual, this diamond-shaped lesion repeated down the forearm. I was stumped; I had no clue what caused the strange plaque.

Eventually the presenter revealed that the rash or lesion was due to applying salt and ice to the forearm. I'll be honest, that was definitely not on my differential. I even Googled "diamond rash on forearm" and pictures of psoriasis and allergic reactions popped up – not salt and ice. 

Interestingly, when I showed my sister the image she immediately diagnosed it as the "Salt and Ice Challenge" from TikTok. My sister is in high school and has had no medical training. But she does have expertise as a Gen-Zer – the generation of Americans similar to Millennials, like me, but according to the Pew Research Center, also the most educated, technologically savvy, and ethnically diverse generation yet. This combination of traits adds to and challenges our collective conversation and identity and in some cases like mine, offers valuable knowledge for our profession. 

Although unexpected, my sister now joins the group of professors, colleagues, and patients that have offered their unique experiences to help shape my education. Given my learning experience, I encourage others to welcome our younger peers to the table and listen to what they have to say. 

KAITLYN: Born as the first digital natives, Gen Zers take full advantage of it in becoming modern-day innovators, educators, and reformers. The internet and social media support our worldwide connection and collaboration with others. Gen Zers exhibit great courage to go beyond the norms established by previous generations. 

Gen Zers make great experimenters, testing one trend after another – each one leaving a unique impact. However, a downside to some influential trends is the hidden underlying danger behind them. Is this risky? What are the consequences? Those concerns are seldom raised and tend to go unnoticed by Gen Z. 

Unintended consequences occur from time to time, but one positive takeaway could be a potential lesson to be learned and taught to others. To my surprise, I found myself having to explain the popular “Salt and Ice Challenge” to my clueless older brother – a Millennial.

Gen Z is the future. Curious, we strive to be educated and continue to investigate answers to the unknown. I hope the trends we explore or the new measures we create can ultimately help make the world a better place. 

COVID-19 Vaccine Distribution Webinar

December 16, DCMS hosted a webinar on COVID-19 vaccine distribution featuring Rashmi Chugh, MD, MPH, Medical Director of the DuPage County Health Department. This will be the first of many webinars for the next few months. Click here for the slides to the webinar. Click here for a recording to the webinar.