As payers announce plans to improve prior authorizations, two spine surgeons discuss the changes that would make the most difference for them.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: What is your top priority in the second half of 2025?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, July 8.
Editor’s note: Responses were lightly edited for clarity and length.
Question: Payers announced commitments to improve the prior authorization process. What revisions do you want to see the most?
Brandon Hirsch, MD. DISC Sports and Spine Center (Newport Beach, Calif.): There are many reforms to the prior authorization process that are long overdue. We cannot continue to allow payers, who receive hundreds of millions of dollars of federal subsidies, to ration care in order to grow profits at the expense of patients. Reform should include mandated response timeframes, especially for time-sensitive cases, and the adoption of electronic prior authorization platforms to streamline submissions. Additionally, payers should be required to publish clear, clinically validated criteria and allow for real-time approvals of routinely accepted procedures to minimize care delays. Finally, there should be accountability for denials, including mechanisms for physician-peer review, appeal rights, and audit trails to ensure that medical decisions are made in the best interest of patient care — not cost containment alone.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Perusing the media’s expose on this topic, found the overuse of the word ‘vowed’ in relationship to streamlining the process of prior authorizations and curtailments of delays. Fair enough. Admittedly, our region is quite efficacious and accommodating when it comes to true neurologically and symptomatically compromised patients necessitating surgery. This process, like all other administrative transitions, may require less machination as a renewed focus is made apparent.
Prioritization and stratification would be a great starting point and overarching method to their newfound madness.
