St. Louis-based Ascension has backed new federal legislation to improve the Medicare Advantage program and reduce barriers to senior care.
The system endorsed the Medicare Advantage Improvement Act, or H.R. 8375, which seeks to address ongoing concerns about delays, denials and hurdles that can set back timely treatment, according to an April 21 news release.
“Medicare Advantage was intended to provide more options and improve outcomes for seniors, but in too many cases it is creating new barriers,” Eduardo Conrado, president and CEO of Ascension, said in the release. “Our physicians and care teams see it every day. Prior authorizations and inappropriate denials delay care and create confusion when patients need clarity and support most.”
The release pointed to internal Ascension data that showed Medicare Advantage plans are 70% more likely than traditional Medicare to deny claims because of incomplete medical records and twice as likely based on medical necessity. Although many denials are later overturned, the process can delay care and add strain for both patients and providers.
The Medicare Advantage Improvement Act features measures that would streamline prior authorization, increase transparency, align coverage standards closer with traditional Medicare to cut unexpected costs and curb misuse of artificial intelligence in claims decisions. The proposed legislation would also aim to ensure faster, more accurate payments to providers.
“For clinicians, the most important relationship in healthcare is the one between the patient and the care team,” Tom Aloia, MD, executive vice president and chief clinical officer at Ascension, said in the release. “This legislation takes meaningful steps to reduce interference by insurance companies, respect the independent clinical judgment of providers and ensure patients receive the right care at the right time. It allows us to spend less time navigating red tape and more time caring for people.”
Ascension has also implemented its own tools and support systems to support patients and clinicians navigating Medicare Advantage, but said broader changes are needed.
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