FAH Hospital Policy Blog

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Medicare | Managed Care | FAH Policy Blog Team

FAH Leader Addresses Prior Authorization Issues in AJMC Op-Ed

An op-ed written by FAH President and CEO Chip Kahn appears in this month’s edition of the American Journal of Managed Care (AJMC). The piece focuses on the barriers to care caused by prior authorization policies and lays out ways to reduce those burdens.

He writes, “When quick intervention is necessary, delays can reduce quality of care and increase disease burden. For hospital patients, delays in prior authorization result in longer stays that drive up costs.”

One solution highlighted by Kahn is the Improving Seniors’ Timely Access to Care Act, HR 3107. The bipartisan legislation, which was introduced during the last Congress by Rep. Suzan DelBene (D-WA) with 280 co-sponsors, would take important steps toward improving prior authorization under Medicare Advantage and had broad patient and provider support.

Other actions featured in the piece that would reduce the burden of prior authorization, interfere less with patient care, save administrative costs and better target overuse, waste and abuse include:

  • Ensure prior authorization decisions are timely and negative determinations indicate the reason for the denial;
  • Sunset programs with very high approval rates;
  • Improve transparency by providing detailed information on prior authorization policies and tracking and reporting rates of approvals and denials;
  • Increase standardization of prior authorization policies, operations, and forms through the use of electronic transmission of prior authorization requests;
  • Ensure prior authorization programs between coverage policies;
  • Eliminate additional prior authorization for medically necessary services performed during a surgical procedure that already received, or did not initially require, prior authorization; and
  • Establish “gold carding,” under which payers reduce prior authorization requirements for providers that have demonstrated a consistent pattern of compliance, improving efficiency and resulting in more prompt delivery of health care services.

You can find the complete AJMC piece here.