During an AHA Annual Membership Meeting panel discussion moderated by Marilyn Werber Serafini, executive director for the Health Program at the Bipartisan Policy Center, the challenges of prior authorization policy requirements were addressed. The panel included Shikha Jain, M.D., from the Department of Hematology & Oncology at UI Health, Ruby Kirby, CEO of Bolivar-Camden General Hospital in Tennessee, Kurt Barwis, president and CEO of Bristol Health in Connecticut and AHA board member.
Jain discussed how commercial insurance practices, such as prior authorization, can lead to care delays, administrative burdens, and physician burnout. Kirby and Barwis also spoke about how prior authorization has hindered their ability to provide timely care for their patients. Matthew Szaflarski, Revenue Cycle Intelligence Leader at Kodiak Solutions, highlighted that initial denials for care authorization have increased by over 40% since 2020. Rachel Schwab, assistant research professor at the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, discussed state programs and policies aimed at reducing the burdens of prior authorization, such as improved transparency and extended approval lengths.
Jain emphasized the impact of prior authorizations on patient care, especially for those with advanced diseases who rely on timely treatment. She mentioned that a significant portion of patients require prior authorizations for imaging or drugs, which can result in devastating delays in treatment. Jain expressed that while the concept of prior authorization was well-intended, it is not serving its purpose effectively. The panelists highlighted the need for reforms in prior authorization practices to ensure that patients receive the care they need without unnecessary delays or administrative burdens.
