CHICAGO—The American Medical Association (AMA) announced new policies on emerging health care issues that were adopted at the conclusion of the semi-annual meeting of the AMA House of Delegates.
The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.
The policies adopted by the House of Delegates include:
Eliminating Barriers to Automated External Defibrillator Use
Despite efforts to make automated external defibrillators (AEDs) available in schools, workplaces and public spaces (as supported by AMA Policy H-130.938), studies have shown that the majority of the public either cannot identify an AED or are not aware of where they are located. Delegates endorsed efforts to promote the importance of AED use and public awareness of AED locations by using solutions such as integrating AED sites into widely accessible mobile maps.
“Prompt use of AEDs is key for survival for people experiencing sudden cardiac arrest, which affects over 40,000 people in the public spaces. We need the public more aware of their life-saving potential and how to use them,” said Mario E. Motta, M.D., a member of the AMA Board of Trustees.
Collaborating with Medicare and Medicaid on Prior Authorization Relief
“Before expanding prior authorization programs under Medicare and Medicaid, the AMA wants government officials to carefully consider evidence that prior authorization harms patients and burdens health care professionals,” said Barbara L. McAneny, M.D. “The new AMA policy identifies opportunities where physicians and government officials can work together to create a prior authorization process that reduces administrative burdens, and ensures that Medicare and Medicaid patients have access to timely and necessary care and medications.”
An AMA physician survey shows that prior authorization programs can create significant treatment barriers by delaying necessary treatment, which may in turn adversely affect patient health outcomes. In addition, the AMA survey underscores the significant administrative burdens associated with prior authorization. Medical practices complete an average of 29.1 prior authorization requests per physician per week, and this workload consumes 14.6 hours—nearly two business days—per week of physician and staff time.
The new AMA policy recommends the following processes and parameters to prior authorization programs for Medicare Advantage plans, Medicaid and managed care organizations contracted to deliver Medicaid health benefits:
- List services and prescription medications that require prior authorization on a website and ensure that patient informational materials include full disclosure of any prior authorization requirements.
- Notify providers of any changes to prior authorization requirements at least 45 days prior to change.
- Improve transparency by requiring plans to report on the scope of prior authorization practices, including the list of services and prescription medications subject to prior authorization and corresponding denial, delay, and approval rates.
- Standardize a prior authorization request form.
- Minimize prior authorization requirements as much as possible within each plan and eliminate the application of prior authorization to services and prescription medications that are routinely approved.
- Pay for services and prescription medications for which prior authorization that has been approved unless fraudulently obtained or ineligible at time of service.
- Allow continuation of medications already being administered or prescribed when a patient changes health plans, and only change such medications with the cannot be changed by the health plan without discussion and approval of the ordering physician.
- Make an easily accessible and responsive direct communication tool available to resolve disagreements between health plan and ordering provider.
The policy adds to the steps the AMA is taking to reform prior authorization programs and processes that are costly, inefficient, opaque, and unwarranted in some cases. Through a new website, FixPriorAuth.org, the AMA is giving patients and physicians a way to share their experiences with prior authorization and add their voices to advocacy for reform.
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