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.

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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

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

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