Bipartisan members of the U.S. Senate introduced radiologist-supported legislation Wednesday to reduce the administrative burden of prior authorization in Medicare Advantage.
The Improving Seniors’ Timely Access to Care Act of 2021 follows a similar proposal in the House, which now has 227 cosponsors. Senators are aiming to simplify insurers’ use of such utilization-management tools that can delay necessary care and increase paperwork for radiologists and other providers.
Physician and Sen. Roger Marshall, MD, R-Kan., sponsored the bill, backed by Sens. Kyrsten Sinema, D-Ariz., and John Thune, R-S.D.
“This legislation cuts the red tape hindering healthcare providers across the nation from providing our seniors with quality care in a timely manner,” Marshall said Oct. 20. “The commonsense solutions we are offering were formed in partnership with hundreds of national and state organizations over the last two years, and I am honored to lead this bipartisan, bicameral effort alongside Senators Sinema and Thune.”
Remedies in Senate Bill 3018 would include establishing an electronic process to reduce paperwork, enabling real-time decisions on commonly approved services, and encouraging payers to stick to evidence-based guidelines in making their decisions. Health plans would also be required to report their use of prior authorization and denial rates.
The American College of Radiology said Wednesday that it supports both the House and Senate bills. Others such as the American Society for Radiation Oncology, Medical Group Management Association and American Hospital Association also endorsed the endeavor. One recent study found that radiology is among the medical specialties with the highest rate of services subjected to prior authorization at 91%. One-third of physicians in a recent American Medical Association survey said prior authorization has led to serious adverse events, including hospitalizations and even death.
“Physicians know the best treatment for our patients but they’re often not the ones making the final decision due to artificial barriers constructed by insurance companies,” AMA President Gerald Harmon, MD, said in a statement. “The time delays and administrative burdens associated with prior authorization continue to undermine our patients’ health.”
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.