Issue: Put “Patients Before Paperwork” by advancing policies that will eliminate unnecessary red tape and improve prior authorization processes for patients and their physicians.
Why Action is Needed
Administrative requirements force physicians to divert time and focus away from patient care and can prevent patients from receiving timely and appropriate treatment. They are also a financial burden and contribute significantly to the burnout epidemic among physicians. A 2022 survey of more than 500 doctors from group practices found that 89 percent believe that regulatory burdens increased in the past year, and 82 percent responded that the prior authorization process in particular is very or extremely burdensome.
Prior authorization involves paperwork and phone calls, as well as varying data elements and submission mechanisms that force physicians to enter unnecessary data in electronic health records (EHRs) or perform duplicative tasks outside of the clinical workflow. This inhibits clinical decision-making at the point of care and is an unnecessary burden for physicians and barrier to medical care for patients. The Department of Health and Human Services issued a report in 2022 that detailed abuse in the prior authorization process in which “Medicare Advantage insurers sometimes delayed or denied beneficiaries’ access to services, even though the requests met Medicare coverage rules.”
ACP’s Patients Before Paperwork initiative serves as the foundation for policy recommendations for revising, streamlining, or removing entirely burdensome administrative tasks. The framework and recommendations call attention to the untapped potential of EHRs to improve care as well as provide a better understanding of the daily issues physicians face including prior authorization obstacles. ACP supports the Improving Seniors’ Timely Access to Care Act and the overall standardization and streamlining of the prior approval process for all patient care, including prescription drugs.
The Centers for Medicare and Medicaid Services (CMS) issued several rules at the end of 2022 aimed at revamping prior authorization processes and transparency requirements. ACP is encouraged by this action and sees it as an important step forward for patients and physicians. Congress now needs to do its part to improve physicians’ ability to provide seamless evidence-based care for their patients without unnecessary administrative delays.
Call to Action
- Pass the Improving Seniors’ Timely Access to Care Act, which would simplify the prior authorization process to determine if a prescribed procedure, service, or medication is covered by a health plan in Medicare Advantage (MA). ACP also supports streamlining for other group health plans.
- Support S. 652, the Safe Step Act of 2023, a bipartisan bill that would require group health plans to provide an exception process for any medication step therapy protocol to help ensure that patients can safely and efficiently access treatment.
- Support legislation that facilitates EHR standardization and the adoption of new standards in medical practices.