National legislation aims to simplify the pre-approval of Medicare Advantage | Panda Anku

The bill has strong support from medical groups and lawmakers, but votes in the House and Senate are not yet scheduled.

Primary care physicians are supporting legislation that could improve patient care while reducing the time it takes to obtain prior approval for medical services under Medicare Advantage plans.

Meanwhile, lawmakers are hoping for a fall vote on at least one version of identical bills in the US Senate and House of Representatives.

The Improving Seniors’ Timely Access to Care Act of 2022 has received more than 500 endorsements from organizations across the healthcare industry and bipartisan support from dozens of lawmakers in the House and Senate.

Sen. Roger “Doc” Marshall, MD, R-Kansas introduced the Improving Seniors’ Timely Access to Care Act, p. 3018, with the goal of improving health care for seniors while reducing the workload for physicians and their reduce employees. Will Bensur, Marshall’s press secretary, said medical economics.

With the support of 37 senators and more than 300 representatives, the legislature took a major step in late July when the House Ways & Means Committee voted it forward. That leads to a possible vote in the fall, House Representative Suzan DelBene, D-Washington, said in a press release.

“It’s 2022 and even Congress has moved beyond the fax machine,” DelBene said in a press release. “The healthcare system is complicated at the best of times. Physicians and their patients should not have to call or fax insurance companies or resend documents for procedures that are approved more than 95 percent of the time.”

As an ob/gynecologist, Marshall experienced firsthand the burden of medical paperwork, which can contribute to workplace burnout while also impacting patient outcomes. Physicians practice medicine to “put patients ahead of paperwork,” and Marshall and the other lawmakers recognize that, Bensur said.

“We want to make it easier for doctors to spend more time with their patients,” said Bensur. “In the context of burnout, I think people go back to what they’re passionate about, why they’re doing it. That can certainly help with that.”

How it works

According to Marshall’s office, the bill would introduce a prior approval process to streamline approvals and denials, with national clinical document standards to reduce the administrative burden on physicians and Medicare Advantage plans.

Marshall and the other legislators recognize that prior approval is an important cost management tool — with potentially serious implications for patients and physicians.

According to reports from the US Department of Health and Human Services inspector general in 2018 and 2022, prior approvals can delay or deny the care of seniors who need it. The 2022 review found that 13% of preapproval requests were denied despite meeting Medicare coverage rules, and 18% of denied payment requests were within the rules but there were staff or system processing errors. The title of the audit cited the issue: “Some denials of requests for prior approval by Medicare Advantage organizations raise concerns about beneficiaries’ access to medically necessary care.”

Doctors speak out

In a 2021 American Medical Association (AMA) survey, physicians criticized pre-approval for its impact on patient outcomes and as a serious drain on practice productivity and morale.

In this survey, physicians reported an average of 41 PAs per physician per week, consuming up to 13 hours of work time per week. PA exposure is high or extremely high according to 88% of respondents.

AMA and the American Academy of Family Physicians (AAFP) are among the medical groups supporting the legislation.

“The federal government needs to automate and streamline preauthorization and reduce the overall volume of preauthorizations to improve patient care and minimize the burden on physicians,” the AAFP said in a July press release announcing its letter announcing the Lawmakers urged to streamline the PA process.

“We know firsthand from primary care physicians that prior approval creates an administrative burden for physicians and other clinicians,” AAFP said. “The manual, time-consuming processes used in pre-approval programs put a strain on primary care physicians and their office staff, divert valuable resources from direct patient care, and can delay the initiation or continuation of necessary treatment, resulting in reduced patient adherence and negative outcomes leads to clinical results.”

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