A radiologist-backed push to rein in insurers’ onerous prior authorization policies is gaining steam, lawmakers announced recently.
Representatives first introduced the Improving Seniors’ Timely Access to Care Act in May, hoping to simplify these utilization-management tools that can delay necessary care and increase paperwork. Lawmakers have now gained support from a bipartisan majority in the U.S. House of Representatives with 227 cosponsors, leaders announced Oct. 8.
“Paperwork should never get in the way of seniors accessing timely, critical care,” Rep. Suzan DelBene, D-Wash., said in a statement. “Prior authorization is an important tool, but we need to bring it into the 21st century so that our seniors get the medical attention they need when they need it.”
The bill aims to streamline and standardize how Medicare Advantage plans use prior authorization, along with increasing oversight and transparency. Measures include establishing an electronic process to reduce paperwork, creating a process for real-time decisions on commonly approved services, and encouraging payers to stick to evidence-based guidelines. Plans would also be required to report their use of prior authorization and rate of denials.
One recent study found that radiology is among the medical specialties with the highest rate of services subjected to such scrutiny, at 91% of services in Medicare Advantage. Another estimated the U.S. healthcare system could save $417 million annually by ending paper-based prior authorization.
The American College of Radiology said Thursday that it supports House Resolution 3173 and “continues to urge passage of the bill into law.”
“Physicians spend far too much time on burdensome paperwork and seeking authorization on certain items, when they should be spending that time taking care of their patients,” cosponsor Ami Bera, MD, D-Calif., said in a statement.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.