1/ @AmerMedicalAssn⁩ press release on the urgency to #fixpriorauth:

At the height of the #COVID19 #pandemic, physicians reported being bedeviled by unnecessary, bureaucratic obstacles that the health insurance industry pledged to reduce three years ago.
2/ The data highlights the urgent need for new bipartisan legislation introduced in the House, the Improving Seniors’ Timely Access to Care Act. [TY @RepDelBene @MikeKellyPA @RepBera @RepLarryBucshon for introducing this vital measure.]

[See data here: ama-assn.org/system/files/2…]
3/#OurAMA-conducted survey shows physicians are running into roadblocks because of #priorauthorization, the process of requiring health care professionals to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient.
4/ 1,000 practicing physicians surveyed in Dec 2020—when new COVID-19 cases were soaring—reported that #priorauthorization was widespread. 83% of respondents indicated that prior authorizations for prescription medications & medical services have increased over the past 5 years.
5/ Along with this increased volume of requirements, most physicians reported a continued lack of transparency in #priorauthorization programs. A majority stated it is difficult to determine whether a prescription medication (68%) or medical service (58%) requires prior auth.
6/ This grim reality persists despite the fact that three years ago, the @AmerMedicalAssn and other large health organizations signed a consensus statement that was intended to improve the #priorauthorization process: ama-assn.org/sites/ama-assn…
7/ @AmerMedicalAssn, along with @ahahospitals, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association, and @MGMA, agreed to reforms needed to reduce #priorauthorization burdens and enhance patient-centered care.
8/ “You would think insurers would ease bureaucratic demands throughout a #pandemic to ensure patients’ access to timely, medically necessary care. Sadly, you would be wrong,” said AMA President @subailey.
9/ Given the insurance industry’s lack of progress in voluntarily reducing the burdens of #priorauthorization agreed to in the consensus statement, @AmerMedicalAssn is calling on #Congress to remedy the problem.
10/ The Improving Seniors’ Timely Access to Care Act (HR 3173) takes direct aim at the insurance industry’s foot-dragging and would codify much of the consensus statement.

For a copy of the bill, see: delbene.house.gov/uploadedfiles/…
11/ This bipartisan legislation would require Medicare Advantage (MA) plans to implement a streamlined electronic #priorauthorization  process that complies with technical standards developed by @HHSGov, in consultation with relevant stakeholders.
12/ In addition, the bill would require increased #transparency for beneficiaries and providers, as well as enhance oversight by the @CMSGov on the processes used for #priorauthorization.
13/ Moreover, to ensure that routinely approved care and treatments are not subjected to unnecessary delays, the program would provide for real-time decisions by an MA plan with respect to certain #priorauthorization requests.
14/ Importantly, the bill would also require MA plans to meet beneficiary protection standards, such as ensuring continuity of care when patients change plans.
15/ AMA strongly supports Improving Seniors’ Timely Access to Care Act. The data released…build upon previously published survey results that underscore the significant patient and practice burdens associated with #priorauthorization and the critical need for legislative reform
16/ [Read AMA’s letter of strong support here: searchlf.ama-assn.org/letter/documen…

See AMA 2020 prior auth survey results here: ama-assn.org/system/files/2…]
17/ “There is no room in the patient-physician relationship for insurance-industry barriers. The AMA is dedicated to simplifying & right-sizing #priorauthorization so physicians can properly provide care & patients can receive the timely treatment they deserve,” @subailey said.
18/ “This legislation is a win-win for patients and physicians,” @subailey said.

To learn more and tell your story, visit fixpriorauth.org.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Marilyn Heine

Marilyn Heine Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MarilynHeineMD

17 May
1/ New report from ⁦@AmerMedicalAssn⁩ provides:

•Detailed look at official US healthcare spending estimates through 2019 using data from ⁦@CMSGov
•Preliminary estimates of 2020 health spending from ⁦@Altarum

ama-assn.org/system/files/2…
2/ •Health spending was 17.7% of GDP in 2019 and increased by 4.6% to $3.8 trillion ($11,582 per capita).
•Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019.
3/ • In 2019, spending growth in #Medicare (6.7%) and out-of-pocket payments (4.6%) reached their highest rates in the last decade while private #healthinsurance (3.7%) and #Medicaid (2.9%) were on a downswing.
Read 5 tweets
10 Apr
1/ 👉 “After careful consideration and given the significant concerns set forth...⁦@AmerMedicalAssn⁩ respectfully urges the @TheJusticeDept to conduct a thorough examination of the antitrust ramifications of UHG/Optum’s proposed acquisition of CHNG.” tinyurl.com/e2nfztbr
2/ @AmerMedicalAssn writes:

“There is substantial overlap in markets for health information technology (IT)/analytics services that the merging firms supply to health insurers, physicians, and hospitals.”
3/ “Given this overlap and the companies’ large sizes, it is likely that the merging firms have been, or absent the merger would become, substantial head-to-head competitors.”
Read 16 tweets
17 Mar
1/ @AmerMedicalAssn⁩ strongly supports HR1868 to protect physician practices: tinyurl.com/tna2a8hk

Prevent across-the-board direct spending cuts that threaten financial viability of physician practices, especially during #COVID19 PHE & beyond. @SpeakerPelosi @GOPLeader
2/ HR1868 is vital to protect physician practices:

•Extend current moratorium on the 2% Medicare sequester cuts past the 3/31/21 deadline

•Avoid additional Medicare statutory PAYGO cut of up to 4% triggered by budgetary impact projected under American Rescue Plan Act of 2021
3/ The #COVID19 #pandemic persists and continues to have a substantial fiscal impact on physician practices.

It is critically important that physicians are able to provide frontline care to #Medicare beneficiaries.
Read 12 tweets
15 Mar
1/ Take care to not run afoul of #HIPAA. Lest you risk penalties and jeopardize the patient-physician relationship.

“Protecting information gathered in association with the care of the patient is a core value in health care.” tinyurl.com/45rk8hr4 ama-assn.org/practice-manag…
2/ The Code of Medical #Ethics also states, “However, respecting patient #privacy in other forms is also fundamental, as an expression of respect for patient autonomy and a prerequisite for trust.”
3/ Physicians and hospitals may share patient information without explicit patient consent for treatment, payment, business operations.

@HHSOCR enforces #HIPAA. Voluntary compliance and corrective action without a fine is a goal, but penalties are steep for “willful neglect.”
Read 8 tweets
15 Jan
1/ @AmerMedicalAssn⁩ applauds
decision by ⁦@HHSGov⁩ to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD

However, it is important to keep in mind several considerations: ama-assn.org/press-center/a…
2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.
3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.
Read 12 tweets
9 Jan
1/ @HHSGov⁩ ⁦@SecAzar⁩ has extended the #COVID19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days.
2/ This means that all of the #telehealth and other waivers and flexibilities that have been implemented during the #PHE will remain in effect until at least April 21, 2021.
3/ As in the summary & impact table by @AmerMedicalAssn, the Consolidated Appropriations Act signed into law 12/27/20 included provisions that offset most of the 10.2% budget neutrality adjustment that was slated to take effect for Medicare-covered services provided as of 1/1/21.
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!

:(