AMA, Others Take on Onerous Prior Authorization Process

January 19, 2018

The AMA and other healthcare stakeholder groups announced their intention this week to streamline the prior authorization process for physicians.

Groups Take on Prior Authorization

Various healthcare associations, such as the American Hospital Association (AHA), America's Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA), are teaming to take on the arduous prior authorization process. The groups said the prior authorization process needs to be streamlined, as it has become very repetitive and time consuming for physicians.

The initiative will aim to reduce the number of healthcare professionals subject to prior authorization requests, regularly review the services and medications that require a prior authorization, improve channels of communication between the various stakeholders, and more. "This collaboration among health care professionals and health plans represents a good initial step toward reducing prior authorization burdens for all industry stakeholders and ensuring patients have timely access to optimal care and treatment," AMA Chair-elect Jack Resneck, Jr., MD, said in a statement.

New HHS Division Stirs Controversy

The Department of Health and Human Services (HHS) announced this week it is creating the Conscience and Religious Freedom Division, which will aim to protect healthcare professionals who have a religious objection to a certain treatment or service. At the ceremony where the announcement was made, Roger Severino, who directs HHS's Office of Civil Rights, said: "We are saying, with the launch of this division, you do not need to shed your religious identity, you do not need to shed your moral convictions to be a part of the public square." Critics are concerned the division may open the door for people to discriminate against LGBT patients, Politico reports.

In a statement, the American College of Physicians (ACP) said it would be "particularly concerned if the new HHS division takes any actions that would result in denial of access to appropriate health care based on gender, gender identity, sexual orientation, race, ethnicity, or other personal characteristics." 

Healthcare Causing Poverty

Paying for healthcare is putting many people in poverty, a new research study reveals. Researchers from Harvard University and Hunter College parsed data regarding household medical payments from the Census Bureau's 2010-2015 Current Population Survey and found medical premiums, copayments, and deductibles pushed more than 7 million Americans into poverty in 2014. The researchers found that after taking account of households' medical payments, the incomes of the poorest 10 percent of the population fell by 47.6 percent and that this spending increased overall income inequality.

Steffie Woolhandler, MD a study author who is a distinguished professor of public health at the City University of New York at Hunter College (CUNY/Hunter) and lecturer in medicine at Harvard Medical School, said in a statement: "In many other countries, health care helps cushion the effects of poverty. But our health care financing system drives millions of Americans into poverty and worsens inequality. That's not just a financial problem, it's a medical one because poverty breeds ill-health."

Quote of the Week

How a Broken Health Care System Harms Us All

"This country needs a health care system that affords families the resources to access help, allows physicians to provide appropriate care, and identifies appropriate facilities for patients. Our current system focuses almost solely on episode-based acute illnesses and injuries and, as such, our emergency rooms and hospitals are generally designed to care for these conditions, not the chronic, often debilitating illnesses."
KrisEmily McCrory, MD, family medicine, upstate New York