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ACP Offers Suggestions for Implementation of Electronic Prior Authorization Systems

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In response to a Request for Information, ACP suggests standardizing the process and procedures to ease administrative burden

April 15, 2022 (ACP) -- As national health officials decide how to advance electronic prior authorization (EPA) systems, the American College of Physicians is making sure they understand the scale of the existing problem and the need for reform.

“Prior authorization requests can be a major source of burden for physicians, and therefore, most technological tools that would automate or electronically facilitate the process are very welcome,” said Brian Outland, ACP director of regulatory affairs. “However, our members have pointed out that it remains to be seen whether electronic prior authorization, as implemented, will actually reduce burden rather than making no meaningful difference, or even worse, exacerbating burden.”

The Office for the National Coordinator for Health Information Technology (ONC) agrees, at least in part. In a Request for Information (RFI), it acknowledged that “the prior authorization process is a source of burden for patients, providers, and payers; a cause of burnout for providers; and a health risk for patients when it delays their care.”

According to the ONC, the purpose of the RFI is to solicit comments from the public on how its Health IT Certification Program could incorporate standards, implementation specifications and certification criteria “in order to further explore … stakeholder recommendations and to build on recent efforts related to [EPA].”

In a statement, the ONC predicted that “ultimately, such electronic processes will serve to ease the burden of prior authorization tasks on patients, providers, and payers.”

In a seven-page letter dated March 25, Dr. Zeshan A. Rajput, chair of the ACP Medical Informatics Committee, told the ONC that “standardizing the process and procedures for reporting electronic prior authorization criteria could potentially ease a major source of administrative burden for clinicians who currently use different data, formats, and procedures to process prior authorization requests that vary based on a patient's health plan. The current process often creates unnecessary or duplicative tasks on the part of the clinician and ultimately takes time away from providing high-value patient care.”

ACP also emphasized the importance of reducing the number of prior authorization requests. And it highlighted that “it is not enough for the EPA functionality to exist,” Outland explained. “Vendors must provide the functionality at an affordable rate, and organizations must be willing to adopt the technology. Reliable data show that EPA capabilities can reduce prior authorization request-to-decision time, which can decrease delays in patient access to important treatments and reduce burden and costs associated with nonelectronic prior authorization.”

The ONC has not disclosed a timeline for advancing electronic prior authorization systems. The deadline for comments passed in March 2022. Dr. Mary Greene, director of the Office of Burden Reduction and Health Informatics in the Centers for Medicare and Medicaid Services, said in a statement that “we look forward to reviewing the input received on this RFI and to exploring opportunities for alignment between future ONC policymaking and ongoing CMS initiatives on this critical topic.”

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Back to the April 15, 2022 issue of ACP Advocate