News & Media

MSMS Board of Directors Meet, Discuss Health Can't Wait and Prior Authorization

Wednesday, October 14, 2020

During the October meeting of the Michigan State Medical Society (MSMS) Board of Directors, the Board discussed the latest information in regards to Health Can't Wait, a coalition of patients, physicians, and health care providers dedicated to putting Michigan patients first and ending delays in patients' access to health care, and had a presentation from the Michigan Hospital Medicine Safety Consortium.

Prior Authorization

Senate Bill 612, introduced by Senator VanderWall, is the bill to reform prior authorization and step therapy developed and advocated by MSMS and the Health Can’t Wait Coalition. The bill was substituted and reported overwhelmingly (8 yeas – 0 nays – 2 passes) out of the Senate Committee on Health Policy and Human Services on September 24.

The substitute for SB 612 retained the Coalition’s transparency, clinical review criteria, and appeal process goals. The main changes are as follows:

  1. Requires an electronic prior authorization process.
  2. Utilization review criteria may be developed by an entity that works directly with clinicians (internal or external) if the entity does not have a financial stake in the outcome of the clinical care decision. 
  3. Allows physicians who are conducting the prior authorization reviews to be employed by insurers.
  4. Eliminates the requirement that a physician making an adverse determination must be in the same specialty as the provider who typically manages the condition. This requirement is still intact for appeals. 
  5. Alters the timelines for urgent and non-urgent requests by changing hours to day - - urgent reviews must be done within one business day and non-urgent reviews within two business days and not to exceed seven business days if additional information was needed from the provider.

Senate Bill 612 (S-1) is currently before the full Senate for consideration. MSMS’s focus will be to get the bill voted out of the Senate as soon as possible after the election. Then, there will be about 10 session days to try to get a House hearing and action. Although Blue Cross Blue Shield of Michigan, Michigan Association of Health Plans, General Motors, and other business groups continue to oppose, the health care and consumer coalition is robust and most legislators have been receptive, as they, or a family member or friend, have experienced the hassles of prior authorization and step therapy.

Michigan Hospital Medicine Safety Consortium (HMS)

The Board of Directors had a presentation from Scott Flanders, MD, Program Director, Michigan Hospital Medicine Safety Consortium; Chief Clinical Strategy Officer at Michigan Medicine; and Professor of Internal Medicine – Hospital Medicine at the University of Michigan Medical School           

In April 2020, the Michigan Hospital Medicine Safety Consortium (HMS), with assistance from several BCBSM CQI's, launched a registry focused on patients with COVID-19 in Michigan hospitals in direct response to the global pandemic. This initiative, Mi-COVID19, consists of 40+ hospitals across the state of Michigan working together to improve care for patients with COVID-19.  The goals of the registry are as follows:

  • Identify factors associated with critical illness/severe course and outcomes
  • Identify patient characteristics, care practices, and treatment regimens associated with improved outcomes
  • Understand the long-term complications for hospitalized patients including subsequent rates of readmission, mortality, and return-to-normal activities
  • Evaluate variability of care processes across Mi-COVID19 hospitals and identify processes associated with improved outcomes
  • Utilizing established CQI models, facilitate improvement in care across Michigan hospitals

The registry showed that most patients come from home (80.5%) and most came through the emergency department (93%).  The median age is 63 with a 50/50 balance across gender.  51.4% of patients were African American with many from the SE Michigan/Detroit area.  The median BMI is 30.6 with 60% non-smokers.  Common comorbidities include:  hypertension (65.4%); diabetes mellitus (36.8%); cardiovascular disease (26%); moderate/severe kidney disease (23.3%); and asthma prevalent (12.9%).

The prevalence of confirmed community-onset bacterial co-infections was low. Despite this, half of patients received early empiric antibacterial therapy. Antibacterial use varied widely by hospital. Reducing COVID-19 test turnaround time and supporting stewardship could improve antibacterial use.

Manuscripts on epidemiology and 60-day outcomes are under review.  Additionally, analyses are in process for: 

  • Risk prediction model for severity of outcomes
  • Variation in presenting illness severity over time and across hospitals.
  • Use of intravascular devices and outcomes
  • Co-infection rates and predictors for co-infection in patients hospitalized
  • Health disparities
  • Variability and outcomes with early steroids use in patients
  • Use of opioids/sedatives
  • Variation of in-hospital anticoagulation treatments and outcomes
  • Mental health in discharged patients
  • Obesity and mortality in patients

Doctor Flanders also presented at Fall Symposium on COVID-19. Physicians and health care providers are welcome to view his presentation here.  He begins at the 1 hour and 30 minute mark.