PROTECT PATIENTS’ TIMELY ACCESS TO CARE
Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. The process for obtaining this approval is lengthy, typically requiring physicians or their staff to spend the equivalent of two or more days each week negotiating with insurance companies — time better spent taking care of patients. Patients experience significant barriers to medically necessary care due to prior authorization requirements for items and services that are eventually routinely approved. Additionally, Medicare’s Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging — which affects virtually every medical specialty — requires physicians to consult AUC before ordering advanced imaging services, such as MRIs and CT scans. Like prior authorization, the AUC program is a costly and administratively burdensome program that may delay patient access to vital diagnostic tests.
To ensure timely access to care, policymakers must regulate the use of prior authorization by Medicare Advantage and other federally-regulated plans. Such regulations should, among other things, increase transparency, streamline the prior authorization process and minimize the use of prior authorization for services that are routinely approved. Furthermore, Congress should pass legislation to repeal Medicare’s Appropriate Use Criteria Program and incorporate the use of AUC for diagnostic imaging into Medicare’s Quality Payment Program.
Read full agenda here.
