As both a 24-year Army veteran and an ophthalmologist, I understand the importance of the doctor-patient relationship. I have seen firsthand the need for patients to receive timely treatments. However, prior authorization has created unnecessary administrative burdens for physicians and has ultimately delayed necessary medical care for patients. As a result, this compromises the relationship between the doctor and the patient.
Throughout my time in Congress, I have heard from patient groups, health care providers, and health plans about the urgent need to deliver meaningful change. Because I understand the severity and importance of this issue, I am proud to support, along with a bipartisan group of colleagues, H.R. 3173, the Improving Senior’s Timely Access to Care Act, which will help ensure Americans get the health care services that they need.
Unfortunately, prior authorization can create delays and disruptions for a prescribed treatment that may be lifesaving to an individual. According to an American Medical Association (AMA) survey, about 94 percent of doctors reported delays in care in 2020 due to prior authorization and approximately 30 percent of physicians have reported that it has led to a serious adverse event for a patient.
Recently, thousands of Aetna Medicare Advantage beneficiaries have seen a delay in their cataract surgery due to a policy change that went into effect this past July. Ophthalmologists who perform cataract surgery know that it is a common and highly successful procedure that restores a patient’s vision. Without this surgery, it would be extremely difficult for an individual to perform daily activities without injuring oneself, and some patients may rely on family members for assistance. Aetna’s prior authorization policy for all cataract surgeries goes against objective, evidence-based clinical criteria that was developed by the American Academy of Ophthalmology.
Prior authorization already creates a lot of paperwork for physicians and their practices, but excessive prior authorization makes that task even more burdensome. When insurers deny coverage, doctors and staff alike spend many hours on the phone attempting to appeal the decision. I have heard scenarios from my physician constituents where a practice will take time to submit a prior authorization request, receive approval from the patient’s insurance company, and perform the procedure. Yet, days later, after submitting the claim, will receive a letter from the insurer claiming there was no approval. As a result, the physician and practice now must take more valuable time away from interacting with patients to deal with regulatory red tape.
In the 2020 AMA survey, a physician spends about two business days per week filling out prior authorization paperwork and the cost of prior authorization is estimated from $2,200 to $80,000 per physician each year.
I recognized the need to address the issue of overly burdensome prior authorization requirements, which is why I am proud to support H.R. 3173, the Improving Senior’s Timely Access to Care Act. This bill would create a more transparent process of Medicare Advantage plans prior authorization and would hold insurance companies accountable to delays and denials in care.
I urge my colleagues in Congress to take the first step to streamline the prior authorization process by quickly passing H.R. 3173, so that we can ensure that patients get timely access to care and to have a better relationship with their doctor. As a state senator in Iowa, I passed needed reforms in prior authorization that were ultimately beneficial to both the patient and the physician and were not a costly expense. It is vital that we take similar action now to ensure patients have timely access to necessary medical care.