While major provider organizations welcomed insurers' pledge earlier this week to reform prior authorization, these groups withheld praise without yet seeing the efforts bear fruit.
Bobby Mukkamala, M.D., president of the American Medical Association, said in a statement that patients and physicians both will need to see the promises made yield significant results to ease the headaches around prior auth.
Mukkamala said that many of the elements of Monday's pledge echo a 2018 consensus statement from major payer and provider organizations, such as reducing the number of required prior authorizations, preserving the continuity of care for the patient and expanding automation.
He said the AMA will "closely monitor" the rollout of the prior authorization changes and continue to work with regulators and legislators on this issue.
"We are pleased with the industry’s recognition that the current system is not working for patients, physicians or plans," Mukkamala said. "However, patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to bring immediate and meaningful changes, break down unnecessary roadblocks, and keep medical decisions between patients and physicians."
The Medical Group Management Association echoed the sentiment in its own statement. Anders Gilberg, senior vice president of government affairs, said that despite the 2018 consensus statement, prior auth continues to be a major barrier for docs "year after year."
He added that much of what insurers have promised is required in Medicare Advantage and Medicaid managed care, so bringing those commitments to the commercial market makes sense.
"Seven years after the consensus statement and several CMS final rules later, health insurers appear to finally be taking steps toward implementation," Gilberg said. "We look forward to receiving more details about the initiative and working towards reducing the overall volume and burden of prior authorization requirements."
Terrence Cunningham, senior director of administrative simplification policy at the American Hospital Association, said that while much of what insurers have pledged aligns with the requirements in government programs, their willingness to extend that work to commercial plans is encouraging, as that will reach far more patients. Cunningham also urged the Centers for Medicare & Medicaid Services to closely monitor how insurers are implementing these changes.
"Excessive and overly burdensome prior authorization requirements create barriers to care for patients and contribute to burning out our healthcare workforce," he said in a statement. "We look forward to reviewing the specific ways that the health plans intend to implement their proposals and stand ready to work with them to support meaningful improvements."
Soumi Saha, senior vice president for government affairs at Premier, said that policymakers should use the pledge as a springboard for reform. As the steps outlined in the pledge are voluntary, that's "not the same as enforceable protections."
"Patients and providers deserve more than promises—they deserve accountability," Saha said. "Premier urges policymakers to build on this momentum and lock in real reform. We’re ready to work together to ensure that care decisions stay where they belong: between patients and their healthcare providers."
Meanwhile, America's Physician Groups said it "looks forward to working with its health plan partners as these changes are put in place."
APG said it has advocated for similar changes to those promised by insurers, including responding to a recent request for information on the matter from CMS to suggest the agency standardize the codes where prior authorization is required.
Susan Dentzer, president and CEO of APG, said that while prior auth does play a key role in addressing low-value care and managing costs, it "must be used judiciously and carefully."
"Because many of our physician groups also undertake prior authorization in the close partnerships they have with health plans, we all have a stake in doing it better and getting it right," Dentzer said.