Recent Calls for Change
The American Physical Therapy Association (APTA) recently responded to the Centers for Medicare and Medicaid Services (CMS) call for input regarding PAs, stating that they strongly recommend changes that would reduce administrative burdens in their efforts to increase advocacy efforts placed on their membership.
Additionally, the APTA signed onto the American Medical Association (AMA) letter expressing strong concerns to the House of Representatives Committee reviewing H.R. 3107, the Improving Seniors’ Timely Access to Care Act, meant to streamline and standardize the prior authorization process through Medicare.
While the American Healthcare Insurance Plans (AHIP) group has signed on to support all of the initiatives, insurance payers have been clear that prior authorizations are seen as an effective tool that helps contain costs and manage the care being delivered and the industry has seen the use of prior authorizations increase, not decrease. According to the Medical Group Management Association (MGMA) 90% of healthcare leaders report that payer prior authorization requirements are increasing with no end in sight.
While there has been growing discord about prior authorizations for a number of years with major governmental and industry-representative bodies joining the chorus, little has changed. Even if foundational improvements are considered, the prior authorization process will likely continue in a new form, but still requiring clinician and administrative time to manage. Being proactive to facilitate an efficient process seems to be the best solution.