Alabama physicians are hopeful that a new federal rule from the Centers for Medicare and Medicaid Services (CMS) could alleviate delays in patient treatment for those enrolled in government-sponsored health programs. However, they stress the need for complementary state-level reforms applicable to private insurance plans according to a news release.

The federal rule targets the use of prior authorizations by health plans, a process that requires doctors and patients to obtain approval from insurers before undergoing prescribed treatment. Under the mandate, health insurers participating in Medicare Advantage, Medicaid and the Children’s Health Insurance Program (CHIP) must expedite responses to prior authorization requests and provide detailed justifications for denials.

Dr. George Koulianos, President of the Medical Association of the State of Alabama, emphasized the burdensome nature of prior authorization, noting its adverse impact on patients and healthcare providers alike.

“Prior authorization is a bureaucratic mess and patients pay the price. Imagine forcing a patient with a severe illness to wait days or weeks for authorization from an insurance company to start treatment. Now imagine a doctor having to employ multiple back-office personnel just to manage that insurer-imposed burden. Patients are left waiting for approval of necessary care and physicians are drowning in red tape. This new federal rule is a step forward, but only a small step. We need strong action at the state level to reform prior authorization in order to protect patients and let physicians see more patients instead of spending their time buried in paperwork,” Koulianos said in the release.

A survey conducted by the Medical Association revealed widespread concern among physicians regarding prior authorization requirements, with one-third of respondents spending nearly a full workday each week on these requests. Consequently, 76 percent reported seeing fewer patients daily, resulting in reduced access to care and exacerbating burnout within the medical community.

Physicians are actively engaging with the health insurance sector to address prior authorization challenges collaboratively. Key reforms advocated by doctors include eliminating repeat prior authorizations for patients with chronic conditions and imposing response deadlines of 24 hours for urgent care requests and 48 hours for non-urgent ones.

Dr. Koulianos highlighted the detrimental effects of prior authorization on patient care, physician well-being, and healthcare costs, particularly amid escalating physician shortages.

“There’s no question that prior authorization delays patient care, contributes to physician burnout and increases overall healthcare costs,” Koulianos said. “With physician shortages increasing, we need to do everything we can - like reforming the burdensome prior authorization process - to keep our physician workforce working.”