WTAS: Marshall, Sinema, Thune Working to Prioritize Patients over Paperwork

Press Release

U.S. Senators Roger Marshall, M.D. (R-KS), Krysten Sinema (D-AZ), and John Thune (R-SD) introduced the IMPROVING SENIORS' TIMELY ACCESS TO CARE ACT, bipartisan legislation that would improve timely access to quality care for seniors under Medicare Advantage. Specifically, the bill would modernize the way Medicare Advantage plans and health care providers use prior authorization. This legislation has amassed support from over 320 NATIONAL AND STATE ORGANIZATIONS representing patients, health care providers, medical device manufacturers, and health IT companies across the country.

Here is what they are saying about this legislation that addresses the number one administrative issue for physicians today:

"The bill is a carefully crafted, bipartisan work product that reflects significant input from all direct stakeholders," said Katie Orrico, SVP for Health Policy and Advocacy at the American Association of Neurological Surgeons/Congress of Neurological Surgeons and leader of the Regulatory Relief Coalition. "The congressional team behind this bill focused on transparency, oversight, and modernization of the Medicare Advantage program to benefit patients and the providers and health plans who serve them. We eagerly await congressional action. The bill is ready for the finish line."

"Physicians know the best treatment for our patients but they're often not the ones making the final decision due to artificial barriers constructed by insurance companies," said American Medical Association President Gerald E. Harmon, M.D. "The time delays and administrative burdens associated with prior authorization continue to undermine our patients' health. Nearly a third of physician respondents to a 2020 AMA survey reported that prior authorization led to a serious adverse event -- such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death -- for a patient in their care. The AMA thanks Senators Marshall, Sinema, and Thune for putting patients first by introducing the Improving Seniors' Timely Access to Care Act, which would simplify and streamline the prior authorization processes in Medicare Advantage."

"Hospitals and health systems strongly support the Improving Seniors' Timely Access to Care Act because physicians, nurses and other providers of care should be able to spend their time on patients, not burdensome paperwork," said Stacey Hughes, executive vice president at the American Hospital Association. "Efforts to streamline and standardize prior authorization are long overdue. Used appropriately, prior authorization can be a helpful tool for ensuring patients receive the right treatment, but too often the process results in delayed care, clinician burnout and unnecessary waste in the health care system. The AHA is eager to continue to work with Senators Marshall, Sinema and Thune to make improvements to the prior authorization process that protect patients."

"NCCN is proud to support the Improving Seniors' Timely Access to Care Act," said Robert W. Carlson, MD, Chief Executive Officer of the National Comprehensive Cancer Network. "This legislation offers sensible reforms to ensure America's seniors can access evidence-based, high quality care in a timely fashion. As a developer of nationally-recognized clinical practice guidelines used in real-time prior authorization tools, NCCN knows firsthand that real-time electronic prior authorization, based on evidence, can significantly reduce unnecessary delays in cancer care while also saving money. This legislation would ensure that Medicare Advantage beneficiaries don't have to wait for the care they need."

"The American Osteopathic Association is pleased to support the Improving Seniors' Timely Access to Care Act," said Joseph A. Giaimo, DO, MACOI, FCCP, president of the American Osteopathic Association. "This legislation is an important first step in improving transparency and unnecessary delays in access to care for patients, while simultaneously reducing physician and administrative prior authorization burdens."

"Passage of the Improving Seniors' Timely Access to Care Act would be a giant step forward in having Medicare Advantage plans use 21st Century prior authorization processes," said Blair Childs, Senior Vice President of Public Affairs for Premier. "Today's processes are manual, burdensome and costly. Continuing to use manual and paper based processes contributes to care delays, and there evidence that current approaches cause patient harm. Premier commends the sponsors of the legislation for your leadership and urges the Senate and House to act quickly on this bipartisan, bicameral legislation."

"The Coalition of Long-Term Acute-Care Hospitals strongly supports S. 3018, which would ensure that Medicare patients receive timely access to necessary care and protect those patients from harm caused by unnecessary bureaucratic delays," said Anthony Misitano, Chair of the Coalition of Long-Term Acute-Care Hospitals.

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 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, the bipartisan legislation would:

establish an electronic prior authorization process that would streamline approvals and denials;
establish national standards for clinical documents that would reduce administrative burdens 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
require beneficiary protections that would ensure the electronic prior authorization serves seniors first.
The House companion -- led by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN) -- was REINTRODUCED in May.

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