Urology Times

Urology Times.Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at (847) 517-1050 or info@aacuweb.org for more information.

Inefficient Payer Approval Processes Fail Patients, Frustrate Docs

posted: March 1, 2017

Prior authorization. Preauthorization. Prior approval. Pre-approval. No matter what you call it, these "utilization management" schemes that consume more and more of urologists' days can be redesigned to make them more relevant and more efficient. This is demonstrated by recent attempts to simplify the administrative burden via state law, as well as a set of principles laid out by the American Medical Association and a coalition of physicians, medical groups, hospitals, pharmacists, and patients.

"Preauthorization has escalated beyond reason," according to AACU President Charles McWilliams, MD. "The list of services that require approval seemingly gets longer every few months. My staff spends at least 30 to 60 minutes for every surgery and medication preauthorization."

According to a December 2016 survey of 1,000 physicians conducted by the AMA, 90% of respondents reported that the prior authorization process delays access to necessary care. AACU Health Policy Chair Jeffrey Frankel, MD, said, "Prior authorizations are very disruptive to patient care and have, in a big way, allowed insurance companies to practice medicine without a license."

The AMA survey found that 80% of physicians are "sometimes, often, or always required to repeat [prior authorization] requests for prescriptions when the patient has already been stabilized on a treatment for a chronic condition."

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Legislative Priorities
  • Proper Implementation of MACRA

    Urologists support the goals of Medicare payment reform, but Congress must monitor its implementation to ensure that the intent of MACRA is fully realized and preserved.BackgroundIn April 2015, Congress passed, and the president signed into law, the Medicare Access and CHIP Reauthorization Act (P...

  • Repeal the Independent Payment Advisory Board

    Urologists urge Congress to repeal the Independent Payment Advisory Board (IPAB). We urge Representatives to cosponsor H.R. 849. We urge Senators to cosponsor S. 251 and S. 260. Each of these measures would permanently repeal the IPAB.Take ActionSend an email to Congress, requesting support for H...

  • Support Transparency and Accountability for USPSTF

    Urologists urge Congress to support legislation that promotes greater transparency and accountability from the U.S. Preventative Services Task Force (USPSTF).  We urge representatives to cosponsor H.R. 539, the “USPSTF Transparency and Accountability Act of 2017”.Take ActionSend...

State Advocacy
  • Fair Contracting and Medical Practice Freedom

    Where We Stand Ensure openness and fairness in health care provider contacts. Prevent third-party payors from changing the terms of their provider contract without notice to the provider and without the consent of the provider. Ensure that physician licensure is based upon a physician's...

  • Medical Liability Reform — Expert Witness Qualifications

    Strengthen expert witness standards Ensure that expert witness is from the same specialty as the defendant physician Prevent frivolous lawsuits Improve the practice environment for physicians in your stateWhenever a physician’s conduct is being called into question, it is only fair...

  • Prostate Cancer Awareness & Assessment

    Where We Stand Continue the progress that has been made in the reduction of prostate cancer morbidity and mortality with the appropriate use of prostate cancer testing. Ensure that third-party payors provide for the reimbursement of prostate cancer testing when the patient and his physician...

  • Uniform Prior Authorization for Prescriptions and Health Services

    Where We Stand Prior authorizations cost the health system $728 million in 2012. Prior authorization requests must use a single form, no more than two pages in length. Forms must available for both access and submission electronically. Requests are deemed approved if no response is...

  • Work Force — Scope of Practice

    Where We Stand Allow the maximum patient-to-physician ratio to increase based on the number of physician assistants in a practice. Expand the ability of nurse practitioners and physician assistants to supervise medical assistants when doctors aren’t on the premises.Proactive Physician...

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