'Enough is enough': AMA pushes prior authorization fix

The U.S. Senate must take the opportunity to fix prior authorization by passing the Improving Seniors Access to Care Act, the American Medical Association said in a Nov. 17 post on its website. 

The bill, which passed the House in September, would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denials. It would also require HHS to develop a process for "real-time decisions" on items and services that are routinely approved. 

A companion bill has been introduced in the Senate and currently has 51 co-sponsors, the AMA said in the post. The organization is working to increase that total to 60 or higher. One challenge to garnering support, however, is a Congressional Budget Office report that estimates the bill will likely result in $16 billion in increased spending over 10 years because physicians will have more time to spend with patients after reforms are enacted. 

AMA President Jack Resneck Jr., MD, called the report "totally maddening." 

"Patients who are not getting care because of prior auth will actually get the care they need and that's a negative — totally frustrating," he said in the post. 

Dr. Resneck said AMA's data shows that the average physician across all specialties now does 41 prior authorizations a week. 

"This burden has really spiraled out of control and enough is enough," he said. 

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