(March 3, 2023) – Over the past few years, hospitals and other health care providers have seen increasing requirements associated with the prior authorization process. Originally, the prior authorization process was a method used by insurance carriers to control costs for highly expensive medications and services. However, recently, the process is becoming more burdensome to our health care system. Consequently, it is having a negative impact on patients obtaining needed health care.
A recent survey of Kansas hospitals showed every respondent had experienced prior authorization delays and denials in 2021. Further, 92 percent indicated the prior authorization process often leads to negative impacts on patients, resulting in more tests and treatments that ultimately increase the overall cost of care. Perhaps most concerning was that more than 43 percent of survey respondents suggested the process of prior authorization results in delays of access to medically needed care with many of those reporting that those delays mean longer recovery times, additional hospitalizations and readmissions, life-threatening events for patients, and permanent disability.
KHA has joined forces with several other health care organizations including the Kansas Medical Society, Kansas Academy of Family Physicians, Kansas Dental Association and Kansas Optometric Association to raise awareness with our political leaders on the challenges associated with the prior authorization process. In general, the belief is the prior authorization process is antiquated and administratively burdensome. The Kansas Legislature recently held a hearing on the practice of prior authorization and heard many stories highlighting the patient impact of a burdensome, inefficient prior authorization process.
Kansas is not alone in trying to create a better system when it comes to prior authorization. In fact, Kansas is one of only a handful of states that has yet to modernize its statutes on the topic of prior authorization. Kansas health care organizations have expressed this puts our state at a distinct disadvantage when trying to recruit and retain physicians, nurses and other health care professionals in Kansas. The legislation also has been sponsored on the federal level by Sen. Roger Marshall, Improving Seniors' Timely Access to Care Act, which establishes several requirements and standards relating to prior authorization processes under Medicare Advantage plans.
KHA would like to express appreciation to our elected officials on the state and federal levels that recognize the burden a cumbersome prior authorization process creates. If you have not done so already, we encourage you to reach out to your elected officials and share your stories on the prior authorization process and why Kansas needs to do better!
--Chad Austin