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  • Major Health Industry Groups Look to Streamline Prior Authorization

    While prior insurance authorization may be right up there with death and taxes when it comes to life's certainties, 6 major health industry groups believe the process could be much improved.

    The American Hospital Association, America's Health Insurance Plans, the American Medical Association, the American Pharmacists Association, BlueCross/BlueShield, and the Medical Group Management Association issued a consensus statement outlining 5 ways the health care system could "improve the [prior authorization] process, promote quality and affordable health care, and reduce unnecessary burdens." Those 5 areas are:

    Selective application of prior authorization. The consensus letter argues for basing application of prior authorization on "provider performance on quality measures and adherence to evidence-based medicine or other contractual agreements."

    Regular reviews of prior authorization and adjustments for volume. "Regular review of the list of medical services and prescription drugs that are subject to prior authorization requirements can help identify therapies that no longer warrant prior authorization due to, for example, low variation in utilization or low prior authorization denial rates," according to the statement.

    Better communication and transparency. The group calls for improved communication between health plans, providers, and patients "to minimize care delays and clearly articulate prior authorization requirements, criteria, rationale, and program changes."

    Attention to continuity of care. The statement identifies continuity of care as "vitally important" and urges "additional efforts to minimize the burdens and patient care disruptions associated with prior authorization."

    More automation. "Moving toward industry-wide adoption of electronic prior authorization transactions based on existing national standards has the potential to streamline and improve the process for all stakeholders," the group states in the letter.

    "This consensus statement is a step in the right direction," said Elise Latawiec, PT, MPH, APTA staff lead for practice management. "The areas noted in the statement align very closely with APTA's positions on relieving administrative burdens and its efforts to explore potential solutions, and we are looking at ways to support and collaborate on this important effort."

    Study: To Avoid LBP, Runners Should Think Deep

    Even though they are keeping fit, up to 14% of American runners experience low back pain (LBP) each year. But runners can reduce their risk by developing their deep core muscles, say authors of a recent study in the Journal of Biomechanics (abstract only available for free).

    While many fitness enthusiasts focus on their abs, they may neglect the trunk muscles they can’t see. “Improper function of this musculature may lead to abnormal spinal loading, muscle strain, or injury to spinal structures, all of which have been associated with increased low back pain risk,” say researchers.

    To test this idea, authors used motion capture technology to collect kinematic data from 8 participants with no history of back pain and no recent injuries. The data, gathered while the participants ran, was used to create simulated full-body models in OpenSim, a software tool for modeling movement.

    In the simulations, researchers gradually weakened the models’ deep core muscles, both individually and together. They found that when deep core muscles are weak, superficial core muscles, particularly the superficial longissimus thoracis (LT), tend to overcompensate, which may result in muscle injury or fatigue. And since the superficial LT was most often the muscle overcompensating for weak deep core muscles, it may be “most at risk for fatigue or injury” if deep core muscles are not functioning properly.

    The authors believe that certain deep core muscles appear to be more important than others in runners. “The deep erector spinae required the largest compensations when weakened individually,” note authors, who conclude that “it may contribute most to controlling running kinematics.”

    When all deep core muscles were weak, or when only the deep erector spinae was weakened, there was a significant increase in both compressive and shear spinal loading in the upper back, with a decrease in the lower back. Over time, this could result in damage to the spine and increase the risk of injury, authors warn.

    Authors suggest further research using simulated models to examine core function in running. The study, researchers observe, “is the first step in providing evidence to support the common notion that poor core strength and stability may influence a runner’s risk of developing injuries such as LBP.”

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.