Senators introduce radiology-supported bill to reform prior authorization
Bipartisan members of the U.S. Senate on Tuesday reintroduced radiologist-supported legislation to reform prior authorization under the Medicare Advantage program.
Sens. Roger Marshall, MD, R-Kan., and Mark Warner, D-Va., are proposing the Improving Seniors’ Timely Access to Care Act, which comes with zero costs, according to its co-sponsors. It aims to streamline the “often cumbersome and time-consuming” task of approving requests for imaging and other services under the payment program.
This will allow radiologists and other physicians to “spend more time on patient care” rather than red tape and paperwork. Along with Marshall and Warner, about 45 other members of the U.S. Senate also have signed on as sponsors.
“Prior authorization is the number one administrative burden facing physicians today across all specialties,” Marshall, an OB-GYN specialist for 25 years before joining Congress, said in a statement May 20. “As a physician, I understand the frustration this arbitrary process is causing healthcare practices across the country and the headaches it creates for our nurses.”
Prior authorization is a utilization-management tactic used by payers, requiring physicians and other providers to gain pre-approval for certain services. However, the current system often results in multiple faxes and phone calls by clinicians, the senators note, taking “precious time away from delivering care.”
The bill aims to correct this by establishing an electronic prior authorization process for Medicare Advantage, including standardizing transactions and attachments. It also would increase transparency around PA requirements and their use. Plus, it would clarify Health and Human Services’ authority to establish timeframes for authorization requests, including expedited decisions and real-time rulings for routinely approved items. Marshall and Warner additionally want to require federal agencies to report to Congress on program integrity efforts and ways to further improve prior authorization.
U.S. Reps. John Joyce, MD, R-Penn., Mike Kelly, R-Penn., Suzan DelBene, D-Wash., and Ami Bera, MD, D-Calif., have introduced a companion legislation in the House. In the previous Congress, the bill was supported by a super majority of members in the Senate (60) and majority in the House, with the latter unanimously passing it in 2022. Despite widespread support, the proposal was shelved in budget talks at the end of 2024.
Last year, imaging advocacy groups such as the American College of Radiology, Association of Academic Radiology, Society of Interventional Radiology and the American Society of Neuroradiology voiced support for the previous version of the bill. The American Society for Radiation Oncology (ASTRO) on Wednesday applauded the proposal. Recent survey data from ASTRO found that prior authorization can lead to “dangerous” delays in cancer care and potential abandonment of treatment.
A recent analysis found that radiology faces one of the heaviest burdens from prior authorization in Medicare Advantage. About 91% of diagnostic radiology providers performed one or more prior authorization service request per year, behind only radiation oncology (97%) and cardiology (93%).
“Prior authorization is a persistent and problematic thorn in the side of American healthcare,” Howard M. Sandler, MD, chair of the ASTRO Board of Directors, said in a statement May 21. “Patients and physicians—not insurance companies—should be at the center of treatment decisions.”
The Regulatory Relief Coalition also applauded the bill’s introduction on May 20. Its members include the Medical Group Management Association, American Osteopathic Association, American College of Cardiology and American College of Surgeons, among others.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.