CMS’ New Rule Aims to Streamline the Prior Authorization Process

Additionally, you can participate on a national level by serving on committees. Recently, several otolaryngologists, including Dr. Troublefield, participated in a fly-in event in July with the Alliance of Specialty Medicine. Meetings were set up on their behalf with their respective senators and representatives in Washington, D.C., to discuss concerns about prior authorization, among other issues.

Otolaryngology was the most represented specialty at the event, with 11 dedicated members advocating, Mr. DeCabo said.

When looking to promote change, Dr. Brown recommends that otolaryngologists work through the AAOHSN and other medical associations to develop position statements, clinical guidelines, and advocacy campaigns to promote continued improvements in the prior authorization process.

The Academy has a robust advocacy infrastructure and has the strongest voice in otolaryngology. The AMA also represents the house of medicine in discussions about prior authorization for Medicare Advantage plans. “If you don’t want to march on Capitol Hill, you could support a political action campaign or cover for your partner who is more inclined to take action,” Dr. Brown said.

Physicians can systematically track prior authorization delays and denials, and their impact on patient care. Collect specific examples of delayed treatments, emergency interventions that could have been prevented, and patient outcomes affected by authorization delays. “This data can become powerful evidence for reform efforts,” Dr. Brown said. “Patient stories resound strongest with politicians, medical directors, and regulatory officials.”

Another option is to engage with state and federal legislators to support prior authorization reform bills. Many states have introduced legislation requiring faster turnaround times, limiting step therapy requirements for certain conditions, and mandating transparency in approval criteria. Otolaryngologists can provide clinical expertise to inform these efforts.

You could also participate in meetings with medical directors at insurance companies or serve on clinical advisory committees with insurance companies. “Work to establish evidence-based approval criteria specific to ENT procedures and develop streamlined processes for common, well-established treatments,” Dr. Brown said.

“These approaches work best when combined and sustained over time, because prior authorization reform typically requires persistent, multi-faceted advocacy efforts,” Dr. Brown said.

How Organizations Promote Advocacy

Prior authorization reform has been, and will continue to be, a prioritized advocacy directive of both the AMA and the AAO-HNS.

The AMA lobbied strongly for prior authorization reform, and these efforts contributed to the passage of CMS’s new rule. The AMA also strongly supports the Improving Seniors’ Timely Access to Care Act bill (https://tinyurl.com/ysc7wnh), bipartisan and bicameral federal legislation that would streamline prior authorization procedures in Medicare Advantage, Dr. Brown said.