Every physician, administrator, insurer knows that burdensome prior authorizations delay patient care and indirectly are contributing to physician burnout. This burden has likely made it impossible for physicians to continue their private practices and perhaps has contributed to the merger of practices and systems trying to streamline this process for themselves. When you have a physician, who has to deal with 35 different health insurers with their own requirements and processes for prior authorizations, you can imagine the amount of time required to obtain such so that timely care can be provided to patients. The incentives to deny requests are clear, but there aren’t many incentives for physicians to continue to fight such denials, especially when there’s no compensation, but rather a cost.
Just recently four physicians representing physician associations emphasized the onerous prior authorization requirements and their detrimental effects before a House Committee on Small Business and urged passing of the HR3107 bill. Even though committee members seemed receptive, will they be willing to pass legislation that will streamline the prior authorization process under Medicare Advantage plans, Medicaid, and federally contracted managed care plans and will increase transparency for such beneficiaries on the process used for prior authorization? It’s difficult to say since the bill still needs committee approval before it could move to the floor. Even so, with a crowded schedule for healthcare policy, it’s unclear when this hearing will happen. Even so, Blue Cross and Blue Shield Association aren’t happy with this bill, and will flex their muscle if this bill sees any attraction. Analyses, per Skopos Labs who specializes in Automated Predictive Intelligence, predict that there’s 1% chancethat this bill will be passed.
The language in the bill, as currently written, will streamline and loosen prior-authorization requirements and stop treatment delays for only “medically necessary” procedures, especially those that could lead to a critically ill patient getting sicker. It will be interesting to see how this battle will ensue. If the bill passes, it may be a catalyst for the rest to follow.