Sen. Marshall Responds to New Data Showing Congress Needs to Put Patients over Paperwork

(Washington, D.C., February 11, 2022) – U.S. Senator Roger Marshall, M.D. issued the following statement after the release of new data from the American Medical Association on how prior authorization delays timely access to care, worsens patient outcomes, and continues to burden health care providers.

“Prior authorization is the number one administrative burden facing physicians today, leading to negative patient outcomes and delayed care. This newly released data further underscores how the current process falls short as well as the importance of my bipartisan legislation which would streamline prior authorization,” said Senator Marshall. “I strongly urge my colleagues in the Senate and House to support this bill to provide health care providers with the ability to better serve their patients.”

According to the survey results, more than half of physicians reported that prior authorization interfered with their patient’s access to care. In addition, four-in-five physicians reported that their patients abandoned treatment due to prior authorization struggles with their health plan. And more than one-third found that prior authorization led to serious adverse events including hospitalization, disability, and even death. 

Background:

Prior authorization is a tool used by health plans to reduce spending from improper payments and unnecessary care by requiring physicians and other health care providers to get pre-approval for medical services. But it’s not without fault. The current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization. Building on these principles, Senator Marshall’s bipartisan legislation would:

  • establish an electronic prior authorization process that would streamline approvals and denials;
  • create national standards for clinical documents that would reduce administrative burdens for health care providers and Medicare Advantage plans;
  • create a process for real-time decisions for certain items and services that are routinely approved;
  • increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
  • ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
  • expand beneficiary protections that would ensure electronic prior authorization serves seniors first. 

The Improving Seniors’ Timely Access to Care Act led by Senators Marshall, Sinema, and Thune is supported by Kyrsten Sinema (D-AZ), John Thune (R-SD), Sherrod Brown (D-OH), Debbie Stabenow (D-MI), Mark Kelly (D-AZ), Mike Rounds (R-SD), Tom Carper (D-DE), Bill Cassidy (R-LA), Chris Van Hollen (D-MD), Susan Collins (R-ME), Tina Smith (D-MN), John Boozman (R-AR), Jon Tester (D-MT), Thom Tillis (R-NC), Richard Blumenthal (D-CT), Cindy Hyde-Smith (R-MS), Kevin Cramer (R-ND), and Mike Braun (R-IN).

In addition, Senator Marshall joined Senators Brown, Thune, and Sinema in sending a letter to the U.S. Centers for Medicare and Medicaid Services’ requesting an update on their efforts to streamline prior authorization protocols across various programs. In the letter, the Senators encouraged the administration to use their bipartisan legislation as a framework for upcoming rules. Last month, HHS released a request for information on electronic prior authorization standards to ease the burden on providers – similar to the goals of the bill.

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