“Furthermore, prior authorization decisions are very often made by non-physician health plan employees based on a set of “black box” criteria on delayed schedules that prioritize the health plan’s interests over those of the patient. ”ACR added.
The College presented its shelved Appropriate Use Criteria program (which would require referrers to consult with a decision support organization before ordering advanced imaging procedures for Medicare beneficiaries) as a “minimizing burden alternative to prior authorization.” The ACR sees myriad benefits from the program, including reducing the performance of low-value imaging tests, relieving the burden on overworked radiologists, and saving Medicare $700 million annually.
“To advance implementation of the AUC, ACR proposed revised language to the Senate Finance Committee that would significantly simplify operations,” the university wrote. “We urge CMS to promptly adopt revised and updated statutory text to provide the legal changes necessary to implement the AUC program. It improves patient care by reducing required utilization and associated out-of-pocket costs, while providing a far better and less burdensome utilization management tool than any previous authorization process.”
In prepared remarks, Budget Committee leaders reiterated ACR’s concerns regarding insurer utilization management.
“Particularly troublesome for patients is prior authorization, which can be confusing, cumbersome and inconsistent while healthcare providers spend valuable time documenting and justifying the clinical need for a drug or service.” Poor insurance regulations lead to interruptions in treatment,” said Chairman and Senator Dr. Sheldon Whitehouse. said in a statement. “There is no logic to prior authorization in a values-based system where physicians profit by cutting costs and keeping patients healthy.”
To address this, the White House is proposing that Medicare Advantage plans be required to obtain CMS approval before imposing prior authorization on physicians working in successful accountable care organizations. There is. His bill would also task CMS with identifying the worst historical authorization practices in Medicare Advantage and setting common standards for these requirements across plans.
Ranking Member Sen. Chuck Grassley (R-Iowa) expressed hope that recently announced actions at CMS will ease challenges for PAs.
“I support greater emphasis on prior authorization. CMS should proactively audit Medicare Advantage prior authorization activities to ensure we have a clear understanding. [of] How will patients, health care providers and taxpayers be affected?” Grassley said in prepared remarks.
You can find both the senator’s testimony and a recording of the May 8 hearing. here. ACR also promoted the following comments: News update Published on Thursday.
