New Regulations to Streamline Prior Authorization Will Avert Care Delays, Signaling Win for Family Medicine

FOR IMMEDIATE RELEASE: January 17, 2024

Contact:
Julie Hirschhorn
AAFP Public Relations
jhirschhorn@aafp.org

Statement attributable to: 
Steven P. Furr, MD, FAAFP 
President
American Academy of Family Physicians 

“The American Academy of Family Physicians (AAFP) applauds the Centers for Medicare and Medicaid Services (CMS) for finalizing new regulations to streamline and automate prior authorization processes across payers. This marks significant progress to address care delays and the administrative burden physicians and their patients face daily. Even though primary care improves health outcomes, prior authorization requirements force family physicians and patients to seek approval from health insurers before a recommended test or course of treatment is provided. 

“Family physicians know firsthand how prior authorizations divert valuable time and resources away from direct patient care. We also know that these types of administrative requirements are driving physicians away from the workforce and worsening physician shortages. According to research from the Medical Group Management Association, nearly 90 percent of physicians found prior authorizations to be very or extremely burdensome. Moreover, 97 percent of physicians reported their patients experienced delays or denials for medically necessary care due to prior authorization requirements.

“Electronic prior authorization will help cut down on the time physicians spend requesting and appealing coverage authorization from plans, as well as provide patients with more visibility into their care. However, policymakers must also address the overwhelming volume of prior authorizations that physicians must complete. Physician practices are being forced to hire dedicated staff to handle prior authorizations instead of investing in staff or tools that would enhance patient care. Instead of interfering in the decisions family physicians make in consultation with their patients, our health care system should improve access to the primary care patients need.

“While this final rule is a concrete step toward reducing the glaring administrative burden physicians face, we need congressional action to cement this vital progress. As such, family physicians urge Congress to swiftly pass the Improving Seniors Timely Access to Care Act, which will streamline and standardize prior authorization under the Medicare Advantage program and protect beneficiaries from unnecessary delays in care. This will ensure physicians can do what they do best: treating patients.”

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