CHICAGO—The American Medical Association (AMA) asked Congress to tackle the issue of prior authorization after an AMA survey found that the “unnecessary, bureaucratic obstacles” impeded patient care during the Covid-19 pandemic.
Three years ago, the AMA, the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association, and the Medical Group Management Association signed a consensus statement designed to reform the prior authorization process and promote quality health care. However, despite the consensus to reduce the prior authorization burden and enhance patient-centered care, the 1,000 practicing physicians surveyed in December 2020—when Covid-19 cases were reaching dire new heights—reported that prior authorization is still impeding services.
“Eighty-three percent of respondents indicated that prior authorizations for prescription medications and medical services have increased over the past five years,” the AMA wrote. “Along with this increased volume of requirements, most physicians reported a continued lack of transparency in prior authorization programs, with a majority of physicians stating that it is difficult to determine whether a prescription medication (68 percent) or medical service (58 percent) requires prior authorization.” The majority of respondents (87%) also noted that prior authorization interfered with the continuity of patient care.
“You would think insurers would ease bureaucratic demands throughout a pandemic to ensure patients’ access to timely, medically necessary care. Sadly, you would be wrong,” said AMA President Susan R. Bailey, MD, in a statement.
Since the insurance industry made no moves to address the problem, the AMA is turning to Congress to act by passing the Improving Senior’s timely Access to Care Act. The organizations sent a letter to members of the House to throw its support behind the bill, arguing that as it currently exists, prior authorization is “overused, costly, inefficient, opaque, and responsible for patient care delays.”
If passed, this bipartisan legislation, which was introduced in the House this week, would:
- Require Medicare Advantage (MA) plans to “implement a streamlined electronic prior authorization process that complies with technical standards developed by the Department of Health and Human Services, in consultation with relevant stakeholders.”
- Require “increased transparency for beneficiaries and providers, as well as enhance oversight by the Centers for Medicare & Medicaid Services (CMS) on the processes used for prior authorization (PA).”
- Provide for “real-time decisions by an MA plan with respect to certain PA requests.”
- Require that MA plans “meet beneficiary protection standards, such as ensuring continuity of care when patients change plans.”
“There is no room in the patient-physician relationship for insurance-industry barriers. The AMA is dedicated to simplifying and right-sizing prior authorization so physicians can properly provide care and patients can receive the timely treatment they deserve,” Bailey said. “This legislation is a win-win for patients and physicians.”
John McKenna, Associate Editor, BreakingMED™
Cat ID: 151
Topic ID: 88,151,730,933,190,926,192,927,151,418,928,925,934
