$15 billion win for physicians on prior authorization

Under the leadership of Administrator Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services.

“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” said HHS Secretary Xavier Becerra. “Too many Americans are left in limbo, waiting for approval from their insurance company.” The administration’s action, he said, “will shorten these wait times by streamlining and better digitizing the approval process.”

CMS did the right thing in “heeding patients and the physician community in a final rule that makes important reforms in government-regulated health plans’ prior authorization programs for medical services,” said AMA President Jesse M. Ehrenfeld, MD, MPH.

My latest for the AMA. The whole shebang.