Leading Healthcare Organizations Urge Congress to Reform Prior Authorizations

SEPTEMBER 12, 2019
Patrick Campbell
In a show of solidarity, a conglomerate of leading healthcare organizations sent a letter to Congress earlier this week urging passage of a bill that would protect Medicare Advantages beneficiaries from prior authorization requirements.

The letter is in support of the Improving Seniors’ Timely Access to Care Act of 2019 and was signed 370 organizations including the American Medical Association (AMA).

"While intended to control costs, the unregulated use of prior authorization has devolved into a time-consuming and obstructive process that often stalls or outright revokes patient access to medically necessary therapies," said Paula Marchetta, MD, MBA, president of the American College of Rheumatology (ACR).

The organizations sent the letter in support of the bill, which was introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), to members of Congress on September 9. Citing unnecessary delays that lead to injuries and sometimes the death of patients, the organizations urged members to vote in favor of the legislation.

Organizations such as the Society for Thoracic Surgeons, the American Society of Retina Specialists, and the American College of Physicians also signed the letter. In addition to national organization, the letter was signed by dozens of state-level organizations.

Included in a release from the ACR was multiple references to a 2018 AMA study. That study, which surveyed 1000 physicians, found that 28% reported prior authorizations had led to a serious adverse in patients. Additionally, in patients that required prior authorizations 91% of doctors associated prior authorization  with treatment delays and 75% said issues related to the prior authorization process can lead to a patient abandoning that course of treatment.

"Many healthcare plans now use prior authorization indiscriminately, ensnaring the treatment delivery process in webs of red tape and creating gratuitous hurdles for patients and providers,” Marchetta said. “Patients, physician groups, hospital associations and other key stakeholders all agree that reform is needed."

The letter highlights 5 key reforms the organizations suggest would lessen the burden of prior authorizations on their older patients. Reforms include creating an authorization program that includes a real-time process for items and services, requiring plans to adopt transparent prior authorizations programs that are reviewed annually, and improving the transparency by requiring plans to report Centers for Medicare and Medicare Services on the extent of their use of prior authorization and the rate of approvals or denials.

Additionally, the bill would hold plans accountable for making timely prior authorizations determinations and prohibit additional prior authorizations for medically-necessary services performed during a surgical or invasive procedure that already received prior authorization.

A link to the full letter with a list of signees can be found here.

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