Philip Seo, MD, MHS, is an associate professor of medicine at the Johns Hopkins University School of Medicine, Baltimore. He is director of both the Johns Hopkins Vasculitis Center and the Johns Hopkins Rheumatology Fellowship Program.
The ACR on prior authorization
Prior authorization reform at state and federal levels has been, and remains, high on the list of the ACR’s priorities:
In 2020, the ACR issued a position statement addressing prior authorization and the burdens it creates, and offering a number of recommendations for streamlining the process. The ACR co-authored, with the American Medical Association and other societies, a document outlining Prior Authorization and Utilization Management Reform Principles.
This past fall, the ACR actively supported gold card legislation in Texas that exempts providers with high prior authorization approval rates from prior authorization requirements. The ACR also helps lead the Regulatory Relief Coalition of provider and patient groups working on reducing the burdens of prior authorization.
Finally, the ACR helped develop the language in the bills now in Congress (H.R. 3173 and S. 3018) and is leading the push to get the legislation passed.
You can help. Take a moment and make your voice be heard through the ACR’s Legislative Action Center.
References
- Schneider D. Your health care is the love child of science and insurance. Daily Beast. 2020 Mar 14.
- Boaz RF. Utilization review and containment of hospital utilization: Some implications of providing care in the ‘most appropriate setting.’ Medical Care. 1979 Apr;17(4):315–330.
- Watson I. The utilization review process and the origins of medical necessity. MCG Health. 2018 Jun 21.
- 22020 AMA prior authorization (PA) physician survey. American Medical Association. 2021.
- Electronic prior authorization. CoverMyMeds.
- Statistics. Blue Cross Blue Shield Blue Care Network of Michigan.
- Gee E, Spiro T. Excess administrative costs burden the U.S. health care system. The Center for American Progress. 2019 Apr 8.
- Howell S, Yin PT, Robinson JC. Quantifying the economic burden of drug utilization management on payers, manufacturers, physicians, and patients. Health Affairs. 2021 Aug;40(8).
- Hancock J. Anthem, UnitedHealthcare, other major insurers are running billions behind in payments to hospitals, doctors. 2021 Oct 5. USA Today.
- Walston C. An 18% dividend increase and an 18% upside: Why I invested in Anthem. Seeking Alpha. 2020 Feb 12.
- Consensus statement on improving the prior authorization process.
- US HR3107: Improving seniors’ timely access to care act of 2019.
- ACCSES, Aimed Alliance, Alliance for Aging Research, et al. Letter to Congress. 2019 Sep 9.
- Prior authorization reform initiatives. American Medical Association. https://www.ama-assn.org/practice-management/sustainability/prior-authorization-reform-initiatives.
- H.B. 3459: Exemption from preauthorization requirements for physicians and health care providers providing certain health care services.
