HospitalsRegulatory

House committee throws spotlight on prior authorization burden

September 11, 2019  / Shelby Livingston and Susannah Luthi

Physician associations on Wednesday called on U.S. House of Representatives lawmakers to pass legislation to streamline prior authorization, claiming it places undue burden and costs on physicians.

During a hearing before the House Committee on Small Business, four doctors representing physician associations said onerous prior authorization requirements delay necessary patient care, lead to burn out in physicians and result in worse outcomes.

“The prior authorization process is out of control. It is increasing and rather than a tool for preventing unnecessary or expensive care, prior authorizations negatively impact my patients’ health and is a significant cause for family physician burnout and the closure of small private practices,” Dr. John Cullen, a family doctor representing the American Academy of Family Physicians, told the committee.

Cullen, who practices at the Valdez Medical Clinic in Alaska, described the “chaos” of having to deal with 35 different health insurers that all have their own prior authorization processes and drug formularies that change regularly, making it hard to know in advance what services and medications will be covered.

“My patients rarely blame insurance company for this,” he said. “They blame me for not giving them the medications they need, yell at my staff or just stop taking the medications they need to prevent hospitalization.”

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Chris J. Stewart

Chris currently serves as Chief Operating Officer at Ortho Spine Partners. Prior to that, he was the assistant vice president and business unit leader of Medical Device Management for HealthTrust.

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