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  • 5 months ago
During a House Ways and Means Committee hearing in July, Rep. Suzan DelBene (D-WA) spoke about Medicare Advantage's claims processing system.
Transcript
00:00I now recognize Ms. Delbeni.
00:03Thank you, Mr. Chairman, and thank you to our witnesses for joining us today.
00:07I'm glad we're here to discuss health care.
00:10With the Republican mega bill stripping over 15 million Americans off of their health coverage,
00:16I can't think of a timelier topic.
00:18And while coverage is incredibly important,
00:21many Medicare Advantage beneficiaries know that coverage is just the first step to receiving needed care.
00:28One thing I consistently hear from seniors in my district is the frustration,
00:33and many have talked about this,
00:34the frustration they have with getting procedures and treatments approved by their insurer.
00:39We all know that this is prior authorization.
00:43This practice has denied life-saving care to Medicare beneficiaries.
00:47It shouldn't take multiple phone calls or even faxes to get a routine procedure approved.
00:54The Trump administration recently announced a voluntary agreement
00:57it reached with the health insurance plans
00:59to alleviate some of the problems with prior authorization.
01:03However, four days later,
01:05CMS announced a plan to increase the use of prior authorization in traditional Medicare.
01:13And who is allowed to contract with CMS to review prior authorization claims?
01:19The Medicare Advantage plans.
01:21So, this is a case of one step forward and two step back.
01:27In 2023, Medicare Advantage plans made 50 million determinations,
01:32and of those determinations that were denied, over 80 percent were eventually approved.
01:37Mr. Fielder, how much time did these appeals take,
01:42and how much does it cost to constantly re-review these claims?
01:46Mr. So, I'm not aware of data that speaks specifically to the amount of time consumed
01:52in navigating appeals, but we do have data looking at how much time providers spend
01:57navigating prior authorization processes generally.
02:02You know, if you're talking about physicians, it's, you know, hours out of their work week.
02:05If you're talking about non-physician practitioners, it's often more.
02:08And, of course, the administrative staff that work for them,
02:11it can be a, you know, substantial fraction of what they do all day.
02:14So, it is a substantial consumer of time for physician's offices,
02:20for other types of health care providers.
02:22And, obviously, you know, that means it's a substantial driver of cost as well.
02:27And not actually going towards providing health care at that moment.
02:31My colleagues and I agree that this is an issue,
02:34and we've been working for years to reform prior authorization.
02:38Recently, the Trump administration hosted a roundtable
02:41that highlighted the negative impacts of prior authorization.
02:45And after years of effort to reform prior authorization,
02:48it seemed like we were all on the same page.
02:50However, just days after the administration's roundtable,
02:53CMS announced their new WISER model,
02:57which contracts with private companies, including Medicare Advantage plans,
03:01to increase the utilization of prior authorization in traditional Medicare.
03:05This model is running in six states, including in my home state of Washington.
03:11To make matters worse, CMS has indicated that model participants will be compensated
03:16based on a share of averted expenditures.
03:20This approach appears to reward participants based on the volume or cost of care
03:25they prevent from being delivered or paid,
03:28once again creating this perverse incentive to deny care in order to make a profit.
03:33Mr. Fielder, with all that we know about the abuses of prior authorization,
03:38is it a good idea to implement this tactic in traditional Medicare?
03:42So as some of my fellow panelists have talked about,
03:45I think it's about striking the balance.
03:47I think broader use of prior authorization in traditional Medicare
03:50could be appropriate if it's done in a thoughtful way.
03:53That being said, I'm sympathetic to the concern
03:57that the particular compensation structure that CMS is thinking about here
04:01does create incentives for plans to, or for the contractors in this case,
04:07to deny requests that should be approved.
04:10And I'm, it's, I think, not clear that the safeguards that the model notionally has an effect
04:15to address those concerns are going to be adequate to the task.
04:18So I think this is the place where the devil is really in the details.
04:21And I guess, you know, probably the most important thing is,
04:25will this model make it easier for seniors to get the care that they deserve?
04:28I think, whatever its merits, it's hard to see how it would expand access to care.
04:33And I think that's got to be an important priority for everyone here.
04:38Thank you all.
04:38I yield back, Mr. Chairman.
04:41Ms. Miller, you...
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