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 costly and administratively burdensome, which 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 health plans. Such regulations should, among other things, increase transparency, streamline the prior authorization process and minimize the use of prior authorization for routinely approved services. Furthermore, Congress should pass legislation to repeal Medicare’s Appropriate Use Criteria Program.
CHAMPION FAIR REIMBURSEMENT
Over the past 22 years, Medicare physician payments have fallen 26%. The combination of these cuts, along with high inflation and workforce shortages, will have negative consequences as seniors face difficulty accessing care from the physician of their choice. In addition, Medicaid payments are typically 30% below Medicare and well below commercial rates, raising significant health equity concerns. Moreover, new regulations implementing the No Surprises Act (NSA) have unfairly empowered health plans to drive down provider reimbursement. Finally, the COVID-19 pandemic demonstrated the need to expand telehealth options.
To ensure access to vital neurosurgical services, policymakers must take steps to improve the Medicare physician payment system by providing an inflationary payment update, revisiting budget-neutrality requirements, maintaining the 10- and 90-day global surgery payment package — including preventing the Centers for Medicare & Medicaid Services (CMS) from using arbitrary, flawed or incomplete data to value global surgery codes — and improving Medicare’s value-based care programs, particularly by leveraging the use of physician-led clinical registries. Steps
should also be taken to close the gap between Medicaid and other insurer payments to reduce access to care disparities. Federal regulators must also follow the clear language of the NSA and implement a fair process for resolving provider and health plan payment disputes. Finally, Congress should permanently expand telehealth, including increased payments for telehealth visits, removing geographic restrictions for telehealth services and allowing flexibility on telehealth modalities, such as audio-only.
FIX THE BROKEN MEDICAL LIABILITY SYSTEM
Our nation’s medical liability system is broken — it costs too much, takes too long to resolve claims and does not serve the needs of patients or physicians — and the fear of lawsuits forces physicians to practice defensive medicine, which is estimated to cost between $46 billion to $300 billion annually.
Congress can fix the system to reduce health care costs, preserve patient access to medical care and end medical lawsuit abuse by adopting common sense, proven, comprehensive medical liability reform legislation. Federal legislation modeled after the laws in California or Texas — which includes reasonable limits on non-economic damages — represents the “gold standard.” Other solutions should be adopted, including liability protections for physicians who volunteer their services and follow practice guidelines established by their specialties. Finally, the Federal Tort Claims Act should apply to services mandated by the Emergency Medical Treatment and Labor Act.
ALLEVIATE THE BURDENS OF ELECTRONIC HEALTH RECORDS
Physician burnout is at an all-time high, with nearly 63% of physicians reporting signs of burnout, impacting physicians and patients alike. A leading cause of burnout is the electronic health record (EHR) and the estimated one billion clicks per day, contributing to toxic stress in physicians. The economic impacts of burnout are also significant, costing the U.S. some $4.6 billion every year. Lack of interoperability, poor EHR usability that does not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and pages and pages of useless template-based patient notes are but a few of the frustrations physicians have with electronic health records.
Policymakers must take all necessary action to correct the current state of EHR technology, achieve interoperability, prevent data blocking, improve functionality, and hold EHR vendors accountable for delivering user-friendly systems that serve physicians and their patients.
Click here to view the full 2024 Legislative and Regulatory Agenda
