5 ms·

Its not just presciptions. Its eligibility , claim submission, prescriptions, etc. This is really affecting doctors and patients. Patients are not getting the

Its not just presciptions. Its eligibility , claim submission, prescriptions, etc. This is really affecting doctors and patients. Patients are not getting the drugs they need or the authorization for a critical procedure. Doctors' cash flow is interrupted. A lot of admin workers are backed up, and that itself is leading to problems too. Why the backup? Its not just electronic data exchange being offline. Its that everything is now "going to paper" (submitted hard copy) which requires humans. Those humans used to take care of the actual work. Now they are stuck shlepping paper from A to B instead. I submitted two links explaining this in more detail yesterday https://news.ycombinator.com/item?id=39561697 https://news.ycombinator.com/item?id=39561697

IG_Semmelweiss 3y ago
Brief summary of the situation (as of 3/1) Impacted services: -Electronic Prescriptions -Several Patient Record Sharing (PRS) systens -Claim Submission -Prior Authorization Appeals -Almost everything involving Fax + UHC Restored services: -Electornic Prior Authorizations (ePA) submissions -Real-time benefit checks
londons_explore 3y ago
Sometimes this kind of event is the trigger to design a more human-efficient process. For example, if it goes on longer, the FDA might allow the majority of drugs to be sold directly on online marketplaces like Amazon without a prescription. That would remove a huge amount of paperwork and doctors appointments for a massive number of people. Let's be honest, the majority of prescription drugs don't have an abuse risk.
- IG_Semmelweiss 3y ago
  Nah. We wont even allow people to import drugs from canada. Meanwhile, canadians are the nicest, most honest people you will meet. You have a positive outlook and that deserves kudos, but its not going to happen, at least in relation to the current fiasco. The pharmacy lobby is too strong.
  - vinay427 3y ago
    > We wont even allow people to import drugs from canada. This seems false based on countless anecdotal experiences and various sources online [1]. Individuals with a valid prescription can have that (once issued by a Canadian/provincial licensed professional) filed and bring it with them or have it shipped through online marketplaces that integrate most of these steps. Suppliers importing from other countries seems to still be illegal although Florida seems to have recently passed a law and received FDA authorization to do this for some drugs [2]. [1]: https://www.singlecare.com/blog/ordering-medications-from-canada/ https://www.singlecare.com/blog/ordering-medications-from-ca... [2]: https://www.kff.org/policy-watch/what-to-know-about-the-fdas-recent-decision-to-allow-florida-to-import-prescription-drugs-from-canada https://www.kff.org/policy-watch/what-to-know-about-the-fdas...
- AnarchismIsCool 3y ago
  There might be some risk with idiots taking z packs for colds and creating more super bugs but there's definitely less stupid ways of doing this. People who take critical stuff regularly usually have to ration drugs so they have a store in case of emergencies. If you travel somewhere and you forget your life saving drugs you then have to spend a good chunk of your trip grovelling to the pharmacist and doctor (depending on the drug) to get an emergency refill if the drug is even available in that location. The whole system is bonkers.
  - spaceguillotine 3y ago
    i have to do this rationing, i skip a dose a couple times a month to slowly build up a reserve, it came in handy on multiple occasions where insurance was holding up meds.
- Beijinger 3y ago
  "Let's be honest, the majority of prescription drugs don't have an abuse risk." It is absolutely disgusting, that you need a prescription for pharmacy items. There is nothing better than going into a pharmacy and just being able to buy what you need. Never had any problems in Colombia, Brazil, Russia and rarely in China. What about people without health insurance?
  - dotancohen 3y ago
    > What about people without health insurance? Are you suggesting that these people do not see doctors and self-diagnose? I could see an argument that making the drugs OTC without prescription may do this population more harm than good.
    - MathMonkeyMan 3y ago
      That's a good point, but honestly I don't know what the net effect would be. Remember that in the US, drug companies market to patients, even though it's the doctor that must prescribe the medication. In other countries, this is illegal. Maybe the barrier of a doctor's visit is not so relevant. Or, maybe it's what prevents things from becoming completely unhinged...
      - dotancohen 3y ago
        > in the US, drug companies market to patients Really? Why?
        Geisterde 3y ago
        In some sense, they are a company like any other, why restrict their ability to advertise? Then again, its not exactly good intentions that got us here.
        Jochim 3y ago
        Opioid epidemic
- crotchfire 3y ago
  This is what Mexico does, and it works fine. There are no prescriptions in Mexico. Medications which are scheduled controlled substances (amphetamines, codiene, morphine, etc) are sold directly by hospitals. There really aren't many of these, and hospitals already have to stock most of them for surgical use. Everything else is cash over the counter. And pseudoephedrine is illegal because of pressure from the US.
  - raffraffraff 3y ago
    I'm glad pseudoephedrine is legal where I live. Once in a blue moon, if I need it, I can get it. Is it illegal in Mexico because meth comes from there in significant quantities?
    - crotchfire 3y ago
      It's illegal in Mexico because the US put pressure on them. The US said "you need to stop selling this without a prescription system". So Mexico stopped selling it entirely.
      - raffraffraff 3y ago
        That's crazy. I can but it over the counter without a prescription.
        crotchfire 3y ago
        Not without showing ID, you can't. And the ID tracking system is part of the prescription system, even though there's no doctor involved. It's why you can only buy pseudoephedrine from pharmacists.
  - andyjohnson0 3y ago
    What about drugs that can have harmful interactions with a person's other health conditions or other drugs that they are taking? A big part of the role doctors and pharmacists in the prescribing process is to guard against this. Are ordinary, non-medically qualified people really supposed to navigate this on their own?
- John23832 3y ago
  Yea, this screams multi drug resistant infections.
- mistrial9 3y ago
  there is a system diagram of roles; this system serves several purposes at once, some of the roles accelerate or benefit from, different purposes; there is so much money involved that the money becomes a driver aside from intended purposes. The system is being attacked / interfered with, almost certainly over the money parts. Patients using the product are by definition not reliable for self-prescribing (argue against this all you want, there is a lot there) Specialization has risen profoundly in the digital age. Even full time MD's do not know all the aspects of the prescriptions; even full time pharmacists do not know all the medical case context; patients know almost none of this as a whole, though the have intense incentives to think they do, or try to, to varying degrees of success. A suggestion of "just let the markets and customers work it out" is unwise at the least, and certainly will bring unintended consequences. The current system is overly gamed and now failing outright. What to do? just describing a problem space here..
jart 3y ago
> Its that everything is now "going to paper" Is it wrong of me to hope it stays that way?
- jclulow 3y ago
  Yes, frankly. It results in terrible outcomes for basically everyone, which ultimately hurts patients the most.
  - TeMPOraL 3y ago
    Does it? My impression is that going paperless actually made doctors stop doing medicine and start spending 90% of visit time doing bullshit e-paperwork. (Yes, I know it's not bullshit - it's so that right insurers get billed. The most important part of medical art.)
    - deleted 3y ago
      [deleted]
zkanter 3y ago
We are launching drop-in replacements for their APIs: https://www.stedi.com/blog/replacements-for-change-healthcare-apis https://www.stedi.com/blog/replacements-for-change-healthcar...

IG_Semmelweiss 3y ago

Brief summary of the situation (as of 3/1) Impacted services: -Electronic Prescriptions -Several Patient Record Sharing (PRS) systens -Claim Submission -Prior Authorization Appeals -Almost everything involving Fax + UHC Restored services: -Electornic Prior Authorizations (ePA) submissions -Real-time benefit checks

londons_explore 3y ago

Sometimes this kind of event is the trigger to design a more human-efficient process. For example, if it goes on longer, the FDA might allow the majority of drugs to be sold directly on online marketplaces like Amazon without a prescription. That would remove a huge amount of paperwork and doctors appointments for a massive number of people. Let's be honest, the majority of prescription drugs don't have an abuse risk.

IG_Semmelweiss 3y ago
Nah. We wont even allow people to import drugs from canada. Meanwhile, canadians are the nicest, most honest people you will meet. You have a positive outlook and that deserves kudos, but its not going to happen, at least in relation to the current fiasco. The pharmacy lobby is too strong.
- vinay427 3y ago
  > We wont even allow people to import drugs from canada. This seems false based on countless anecdotal experiences and various sources online [1]. Individuals with a valid prescription can have that (once issued by a Canadian/provincial licensed professional) filed and bring it with them or have it shipped through online marketplaces that integrate most of these steps. Suppliers importing from other countries seems to still be illegal although Florida seems to have recently passed a law and received FDA authorization to do this for some drugs [2]. [1]: https://www.singlecare.com/blog/ordering-medications-from-canada/ https://www.singlecare.com/blog/ordering-medications-from-ca... [2]: https://www.kff.org/policy-watch/what-to-know-about-the-fdas-recent-decision-to-allow-florida-to-import-prescription-drugs-from-canada https://www.kff.org/policy-watch/what-to-know-about-the-fdas...
AnarchismIsCool 3y ago
There might be some risk with idiots taking z packs for colds and creating more super bugs but there's definitely less stupid ways of doing this. People who take critical stuff regularly usually have to ration drugs so they have a store in case of emergencies. If you travel somewhere and you forget your life saving drugs you then have to spend a good chunk of your trip grovelling to the pharmacist and doctor (depending on the drug) to get an emergency refill if the drug is even available in that location. The whole system is bonkers.
- spaceguillotine 3y ago
  i have to do this rationing, i skip a dose a couple times a month to slowly build up a reserve, it came in handy on multiple occasions where insurance was holding up meds.
Beijinger 3y ago
"Let's be honest, the majority of prescription drugs don't have an abuse risk." It is absolutely disgusting, that you need a prescription for pharmacy items. There is nothing better than going into a pharmacy and just being able to buy what you need. Never had any problems in Colombia, Brazil, Russia and rarely in China. What about people without health insurance?
- dotancohen 3y ago
  > What about people without health insurance? Are you suggesting that these people do not see doctors and self-diagnose? I could see an argument that making the drugs OTC without prescription may do this population more harm than good.
  - MathMonkeyMan 3y ago
    That's a good point, but honestly I don't know what the net effect would be. Remember that in the US, drug companies market to patients, even though it's the doctor that must prescribe the medication. In other countries, this is illegal. Maybe the barrier of a doctor's visit is not so relevant. Or, maybe it's what prevents things from becoming completely unhinged...
    - dotancohen 3y ago
      > in the US, drug companies market to patients Really? Why?
      - Geisterde 3y ago
        In some sense, they are a company like any other, why restrict their ability to advertise? Then again, its not exactly good intentions that got us here.
        Jochim 3y ago
        Opioid epidemic
crotchfire 3y ago
This is what Mexico does, and it works fine. There are no prescriptions in Mexico. Medications which are scheduled controlled substances (amphetamines, codiene, morphine, etc) are sold directly by hospitals. There really aren't many of these, and hospitals already have to stock most of them for surgical use. Everything else is cash over the counter. And pseudoephedrine is illegal because of pressure from the US.
- raffraffraff 3y ago
  I'm glad pseudoephedrine is legal where I live. Once in a blue moon, if I need it, I can get it. Is it illegal in Mexico because meth comes from there in significant quantities?
  - crotchfire 3y ago
    It's illegal in Mexico because the US put pressure on them. The US said "you need to stop selling this without a prescription system". So Mexico stopped selling it entirely.
    - raffraffraff 3y ago
      That's crazy. I can but it over the counter without a prescription.
      - crotchfire 3y ago
        Not without showing ID, you can't. And the ID tracking system is part of the prescription system, even though there's no doctor involved. It's why you can only buy pseudoephedrine from pharmacists.
- andyjohnson0 3y ago
  What about drugs that can have harmful interactions with a person's other health conditions or other drugs that they are taking? A big part of the role doctors and pharmacists in the prescribing process is to guard against this. Are ordinary, non-medically qualified people really supposed to navigate this on their own?
John23832 3y ago
Yea, this screams multi drug resistant infections.
mistrial9 3y ago
there is a system diagram of roles; this system serves several purposes at once, some of the roles accelerate or benefit from, different purposes; there is so much money involved that the money becomes a driver aside from intended purposes. The system is being attacked / interfered with, almost certainly over the money parts. Patients using the product are by definition not reliable for self-prescribing (argue against this all you want, there is a lot there) Specialization has risen profoundly in the digital age. Even full time MD's do not know all the aspects of the prescriptions; even full time pharmacists do not know all the medical case context; patients know almost none of this as a whole, though the have intense incentives to think they do, or try to, to varying degrees of success. A suggestion of "just let the markets and customers work it out" is unwise at the least, and certainly will bring unintended consequences. The current system is overly gamed and now failing outright. What to do? just describing a problem space here..

jart 3y ago

> Its that everything is now "going to paper" Is it wrong of me to hope it stays that way?

jclulow 3y ago
Yes, frankly. It results in terrible outcomes for basically everyone, which ultimately hurts patients the most.
- TeMPOraL 3y ago
  Does it? My impression is that going paperless actually made doctors stop doing medicine and start spending 90% of visit time doing bullshit e-paperwork. (Yes, I know it's not bullshit - it's so that right insurers get billed. The most important part of medical art.)
  - deleted 3y ago
    [deleted]

zkanter 3y ago

We are launching drop-in replacements for their APIs: https://www.stedi.com/blog/replacements-for-change-healthcare-apis https://www.stedi.com/blog/replacements-for-change-healthcar...