In responding to a federal agency’s questions about the potential impact of electronic prior authorization, the Texas Medical Association – as always – came out strongly against unnecessary prior authorizations in general, while specifically encouraging regulators to advance a version of Texas’ new “gold card” law to curb those practices.
A March 25 letter from TMA President E. Linda Villarreal, MD, responded to the Office of the National Coordinator for Health IT’s (ONC’s) previous request for information on “Electronic Prior Authorization Standards, Implementation Specifications, and Certification Criteria.” ONC’s seven-page request included several specific questions meant to measure electronic prior authorization’s impact on practitioners.
Although TMA appreciates “efforts made to decrease the inefficiencies of prior authorizations, an efficiency applied to unnecessary work only allows users to do unnecessary work faster,” Dr. Villarreal’s letter said, calling the burden prior authorizations have caused “unsustainable.”
One of the questions ONC had posed was, “To what degree is availability of electronic prior authorization capabilities within certified health IT likely to reduce burden for health care providers who currently engage in prior authorization activities?”
TMA responded that although electronic prior authorization may show some “initial efficiencies,” medicine is concerned it “may turn into the same data bloat that physicians experience with electronic health records.” TMA’s letter noted when physicians are forced to embark on the prior authorization rigmarole for medications, “[t]he value of the time spent by the physician on this activity often costs more than the medication. Physicians are not optimistic that payers will invest in the technology tools needed to make electronic prior authorizations as efficient as ONC envisions.”
Dr. Villarreal’s letter also advocated for physicians to be paid for the time spent on prior authorizations, and against certified health IT developers passing on costs to physicians that result from adding electronic prior authorizations to their products. “It is the payer community that demands the volume of prior authorizations and therefore the payer community should bear the cost,” the letter said.
TMA closed by saying ONC’s leadership on electronic prior authorization “has the potential to reduce the volume of prior authorizations while increasing efficiency and reducing physician burden.” TMA added ONC should consider advancing the “gold card” approach codified in Texas as House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The gold-card bill allows physicians to earn continuous exemption from prior authorization for a medication or service by earning approvals on at least 90% of prior authorization requests for it.
“This allows patients to get the treatment needed quickly while reducing administrative burden for physicians,” Dr. Villarreal wrote.
Last Updated On
March 30, 2022
Originally Published On
March 30, 2022