The difficult prior authorization policy requirements were addressed during a panel discussion at the AHA Annual Membership Conference moderated by Marilyn Werber Serafini, executive director of health programs at the Bipartisan Policy Center.
Shikha Jain, M.D., of UI Health's hematology-oncology division, who appeared in a recent New York Times video on prior authorization, said that some commercial insurance practices, including prior authorization, can delay treatment and increase the burden on hospitals, health systems, and providers. He said this would lead to administrative burden. Physician practice and physician burnout. Ruby Kirby, CEO of Bolivar-Camden General Hospital in Tennessee, and Kurt Barwis, president and CEO of Bristol Health in Connecticut and a member of the AHA Board of Directors, agree that prior authorization is essential for patients. and how it hinders their ability to provide appropriate and timely care to patients.
Matthew Zafraski, revenue cycle intelligence leader at Kodiak Solutions, said initial denials of long-term care certifications have increased by more than 40% since 2020. Rachel Schwab, assistant professor at the Center on Health Insurance Reform at Georgetown University's Health Policy Institute, discussed the programs and policies that some states are beginning to pursue to reduce the burden of prior authorization. This includes increasing transparency and extending pre-approval approval periods. We offer coverage and rollover if a patient changes insurance plans, or for patients with high pre-approval rates, a “gold card” that waives pre-approval requirements for certain medications or procedures. .
“Let's assume you have a clinic with 20 patients, and at least five to eight of them require prior authorization for imaging or medication,” Jain says. “And the patients we treat at the University of Illinois are people who often seek medical attention when their disease is advanced. So for them, delays in starting treatment or delays in imaging can be , the clinical impact is even greater. But when cancer treatment is delayed, it can be truly devastating.”
“The idea of pre-approval was a good one, but it doesn't serve its purpose,” Jain said.
