As a 24 year military veteran and ophthalmologist, I understand the importance of the doctor-patient relationship. I saw first-hand the need for patients to receive timely treatment. However, prior authorization created unnecessary administrative burdens for doctors and ultimately delayed necessary medical care for patients. As a result, it compromises the relationship between doctor and patient.
Throughout my time at Congress, I heard from patient groups, healthcare providers and healthcare plans about the urgent need for meaningful change. Because I understand the seriousness and importance of this problem, I am proud to support, along with a bipartisan group of colleagues, HR 3173, improvement Act respecting rapid access to care for the elderly, which will help ensure that Americans get the health services they need.
Unfortunately, prior authorization can cause delays and interruptions for prescribed treatment that can save an individual’s life. According to a survey by the American Medical Association (AMA), approximately 94% of doctors reported delays in treatment in 2020 due to prior authorization and about 30 percent of physicians reported it resulted in a serious adverse event for a patient.
Recently, thousands of Aetna Medicare Advantage beneficiaries have had their cataract surgery delayed due to a policy change which entered into force last July. Ophthalmologists who perform cataract surgery know that it is a common and very 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 themselves, and some patients may rely on the help of their family members. Aetna’s prior authorization policy for all cataract surgeries goes against objective, evidence-based clinical criteria that have been developed by the American Academy of Ophthalmology.
Prior authorization already creates a lot of red tape for physicians and their practices, but excessive prior authorization makes this task even more onerous. When insurers deny coverage, doctors and staff spend many hours on the phone trying to appeal the decision. I have heard scenarios from doctors in my constituency where a practice will take a long time to submit a pre-authorization request, receive approval from the patient’s insurance company, and complete the procedure. Yet a few days later, after submitting the claim, will receive a letter from the insurer stating that there was no approval. As a result, the physician and practice must now devote more valuable time to interacting with patients to cope with regulatory bureaucracy.
In the AMA 2020 survey, a doctor spends approximately two working days per week to complete the pre-authorization documents and the cost of prior authorization is estimated to be between $ 2,200 and $ 80,000 per physician each year.
I recognized the need to address the problem of overly onerous prior authorization requirements, which is why I am proud to support HR 3173, the law on improving the timely access of older people to care. This bill would create a more transparent process for pre-authorization of Medicare Advantage plans and would hold insurance companies accountable for delays and denials of care.
I urge my colleagues in Congress to take the first step in streamlining the prior authorization process by swiftly passing HR 3173, so that we can ensure patients have timely access to care and a better relationship with their doctor. As an Iowa State Senator, I passed the necessary pre-authorization reforms that ultimately benefited both the patient and the physician and were not a costly expense. It is essential that we take similar steps now to ensure that patients have timely access to necessary medical care.
Miller-Meeks represents the 2nd district of Iowa.