AHA shares support of new prior authorization reform in letter to Congress

As the "Gold Card Act of 2023" (H.R. 4968) gains traction, the American Hospital Association (AHA) reiterated its support of the act, this time sending a letter to Congress addressed to the bill’s co-sponsors.

Championed by Representatives Michael Burgess and Vicente Gonzalez, the bipartisan Gold Card Act has captured the attention of major healthcare organizations due to its potential to alleviate the administrative burdens of prior authorization. At its core, the Gold Card Act seeks to address the longstanding issue of prior authorization requirements under Medicare Advantage (MA) plans. These requirements have posed significant challenges for both healthcare providers and patients, often leading to delays in treatment and inefficiencies in the healthcare system. 

Acknowledging these concerns, the AHA has expressed its steadfast support for the Gold Card Act, recognizing its potential to bring about positive change. In the letter, the organization articulates its concerns over the misuse of prior authorization, which can impede timely patient care and contribute to inefficiencies in the healthcare system. 

"While commercial insurers state that prior authorization is a tool to align health care services with a patient’s insurance coverage, the practice too often is used in a manner that leads to dangerous delays in treatment and contributes to waste in the health care system," according to the letter, signed by Lisa Kidder Hrobsky, senior vice president of advocacy and political affairs on behalf of the AHA.

According to the AHA, the legislation would “exempt providers from requiring prior authorization for a MA plan year if the provider had at least 90% of prior authorization requests approved the preceding year." This exemption would provide much-needed relief to healthcare providers who have consistently demonstrated a high approval rate for prior authorization requests.

Ideally, Gold Card programs offer relief from administrative burdens and streamline access to care for Medicare beneficiaries. The act further seeks to establish stability and continuity of care by limiting the frequency of reviews for the Gold Card. Additionally, the bill encourages the Health and Human Services (HHS) Secretary to establish rules regarding the use of prior authorization during transitions between coverage – a provision that aims to minimize disruptions in ongoing treatments, ensuring that patients receive the care they need without unnecessary delays.

The AHA states it represents “5,000 member hospitals, health systems and other health care organizations,” including more than 270,000 affiliated physicians, 2 million clinicians, and 43,000 other healthcare leaders. The Gold Card Act's potential to reshape the landscape of healthcare access has garnered strong support from other influential healthcare organizations as well, including the American Medical Association (AMA)

Despite payers' claims that prior authorization serves cost and quality control purposes, a significant portion of surveyed physicians disagree. According to an AMA survey, one-third of physicians reported that prior authorization has led to serious adverse events for their patients.

Chad Van Alstin Health Imaging Health Exec

Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.

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