Surgeon general hopeful for prior authorization changes

Surgeon General Vivek Murthy, MD, said the stories he heard from clinicians in a recent listening session about the challenges prior authorizations pose were "deeply touching and I'd say disturbing as well."

Dr. Murthy hosted the session with CMS Administrator Chiquita Brooks-LaSure and other CMS officials Jan. 17 to discuss proposed prior authorization reforms. CMS in December issued the proposed rule it says will streamline the prior authorization process and estimates the efficiencies introduced in the proposal would save hospitals and physician practices more than $15 billion over a 10-year period. 

The session was not open to the public, but officials held a call with reporters afterward. 

Dr. Murthy said there was a sense of gratitude and optimism from the clinicians that the reforms offer a "chance for us to truly make a difference on an issue that has plagued clinicians and patients for many, many years." 

In the meeting, Dr. Murthy said officials heard about the extraordinary turnover hospitals are facing in the wake of the COVID-19 pandemic and how the burden of prior authorization has compounded those issues, making the "challenge of keeping clinicians in the profession all the more difficult."  

"The pain is real, but there's also hope that we heard that in partnership with CMS that some of these burdens can be alleviated," Dr. Murthy said. 

The proposed prior authorization reforms would generally apply to Medicare Advantage organizations, state Medicaid/CHIP agencies, Medicaid/CHIP managed care plans, and qualified health plan insurers on the federally facilitated exchanges.

"These constellation of rules are really around trying to make sure we are aligned across payers because that is something we hear time and time again: that it's important that our rules are consistent, particularly as providers, clinicians, patients and increasingly health plans operate in all of the programs," Ms. Brooks-LaSure said. "Making sure we're looking across our plans is a real priority for me personally and the CMS agency." 

Ms. Brooks-LaSure said CMS is still in the proposed rulemaking process and wants to continue hearing from stakeholders. 

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