Table of Contents: September 2017

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Volume 113, Number 9 — September 2017 


The Obstacle Course
In this issue, Texas Medicine looks into prior authorizations, which insurance companies require when physicians prescribe a medication or treatment. Authorizations are designed to keep costs down, but anecdotal evidence shows that in the last year or so, prior authorizations have become abusive. 

Heavy Resistance (pages 18–25)
Dealing with prior authorizations is like running an obstacle course for physicians — and the obstacles keep getting bigger. By Sean Price

A Peer? Nowhere Near (pages 2731)
For 20 years, physicians and their patients have had the option of challenging insurers' preauthorization denials through an independent review organization (IRO). Yet, many physicians still don't even know the IRO option exists. By Joey Berlin

A Fresh Set of Eyes (pages 33–38)
For prior authorizations, insurance companies often require peer-to-peer conversations between a patient's physician and another physician to determine whether the treatment is necessary. These conversations often result in Texas doctors explaining the necessity of the treatment to a physician who's not licensed in Texas and/or is in an unrelated specialty. By Joey Berlin  


Steering Clear of Trouble (pages 3945)
In a cautionary tale for physicians and their relationships with pharmacies, a federal grand jury indicted three physicians and five other people in March, alleging that three pharmacies had received millions in payments from the federal Office of Workers' Compensation for prescriptions of compounded creams used to treat pain, scars, and wounds. By Joey Berlin


Fulfilling a Dream (pages 4752)
The University of Texas Rio Grande Valley School of Medicine has largely dispensed with lectures and focuses more on group learning and practical experience. This and other innovations dovetail with the school's focus on public health, which is vital in a region notorious for high poverty and chronic health problems. Unfortunately, the school has faced budget and staffing problems. By Sean Price


What You Need to Know About ACEs (pages 5357)
Medical evidence shows that the more abuse and neglect children endure, the greater their chances for physical and mental health problems over time. By Sean Price 


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