During the 2022 MSMA Annual Session, our House of Delegates passed Resolution 2 to streamline prior authorization for physicians. This resolution reaffirmed the similar House of Delegates policy from 2021 for MSMA to seek a remedy to streamline the prior authorization process for physicians.
MSMA followed the direction of the resolution on this and many other issues during the 2023 session. We supported a bill with many of the reforms as part of the Mississippi Prior Authorization Reform Act or SB 2622. The bill authored by Senator Walter Michel passed both the Senate and House of Representatives, but it was not signed by Governor Reeves. Although Governor Reeves indicated he supported many of the parts of the bill, he vetoed the bill because he felt it had unintended consequences to increase the cost of healthcare. He pledged his support for getting a better bill in the future.
MSMA is hopeful to continue to work with lawmakers to improve the prior authorization process. This is not only a Mississippi physician issue, but it is a national physician issue that continues to gain traction with government and commercial healthcare plans.
The AMA launched a national campaign to advocate for prior authorization reforms and eliminate requirements to minimize waste, delays, and disruptions in care delivery. According to a physician survey released by the AMA, four out of five physicians report that prior authorization leads to higher costs of healthcare. These higher costs exceed any benefits of cost savings for the requirements and ultimately harm the patients. Excerpts from the survey listed below also substantiate many of our concerns in clinical practice in Mississippi.
Patient Harm - One-third of physicians (33%) reported that prior authorization led to a serious adverse event for a patient including hospitalization, permanent impairment, or death.
Bad Outcomes - Nearly nine in 10 physicians (89%) reported that prior authorization had a negative impact on patient clinical outcomes.
Delayed Care - More than nine in 10 physicians (94%) reported that prior authorization delayed access to necessary care.
Disrupted Care - Four in five physicians (80%) said patients abandoned treatment due to prior authorization struggles with health insurers.
Lost Workforce Productivity - More than half of physicians (58%) who cared for patients in the workforce reported that prior authorizations had impeded a patient’s job performance.
In addition, a significant majority of physicians (88%) said burdens associated with prior authorization were high or extremely high. This costly administrative burden pulls resources from direct patient care as medical practices, in order to complete an average of 45 prior authorizations per physician per week. This consumes the equivalent of almost two business days (14 hours) of physician and staff time. To keep up with the administrative burden, nearly two in five physicians (35%) employed additional staff members to work exclusively on tasks associated with prior authorization.
As part of the AMA’s Recovery Plan for America’s Physicians, the AMA sent recommendations to the Centers for Medicare & Medicaid Services (CMS) that were addressed in the final rules on Medicare. CMS indicated that improvements were made in the coverage criteria and indicated the need for increased transparency that will be available in Medicare Advantage plans to take affect January 1, 2024.
Prior authorization reform is building momentum both at the state and national level. MSMA will continue to advocate for streamlining the process and urge Mississippi insurance carriers to simplify their prior authorization process.
We need your support to continue to advocate for improvements in the prior authorization arena and help move Mississippi healthcare forward.