BY JEFFREY PERKINS, JD, MMS LEGISLATIVE & REGULATORY AFFAIRS COUNSEL
Illustration by Chris Twichell
The Massachusetts Medical Society (MMS) is working to ensure the physicians’ voice is heard loud and clear on Beacon Hill. In September, nine physicians testified before the Joint Committee on Financial Services, part of a coordinated push in support
of prior authorization (PA) reform organized by the MMS and our coalition partners.
The participating physicians provided compelling testimony, underscoring for legislators the burden and strain that current prior authorization requirements place on practices and the devastating impact these requirements can have on patients’ care and
health. The need for prior authorization reform was reinforced with the legislature during a subsequent MMS legislative briefing that was held in the State House and open to all legislators and staff. The briefing was an opportunity to advocate
for MMS’s legislative priorities for this session and to deepen our relationships on Beacon Hill. MMS President Barbara Spivak, MD, facilitated the briefing, which included participation from MMS officers and physician subject matter experts.
MMS-Led Coalition Proposes Critical Reforms to Prior Authorization
The MMS has led a coalition of organizations, including Health Care For All and the Massachusetts Health & Hospital Association, and worked with key lawmakers, including state senator Cindy Friedman, who chairs the legislature’s Joint Committee on Health
Care Financing. We are advocating for comprehensive reforms to PA to improve access to care for patients, increase transparency and consistency, reduce administrative burden, and, importantly, limit the number and types of services for which
prior authorizations are required. Two bills, S.1249, An Act Relative to Reducing Administrative Burden, and H.1143,
An Act to Improve the Health Insurance Prior Authorization Process, maintain prior authorization requirements but propose critical reforms to eliminate the most wasteful and unnecessary practices.
Key components of these bills, if passed, would:
Improve access to and continuity of care for patients by requiring PAs to be valid for the duration of treatment or at least one year and requiring insurers to honor the patient’s PA from another insurer for at least 90 days;
Promote transparency and fairness in the PA process by requiring public PA data from insurers as it relates to approvals, denials, appeals, wait times, and more, and by prohibiting retrospective denials if care is preauthorized;
and
Improve timely access to care and administrative efficiency by establishing a 24-hour response time for urgent care and by requiring insurers to adopt software to facilitate automated, electronic processing of PAs and the
Division of Insurance to implement standardized PA forms.
Prior Authorization Singled Out as Most Common Stressor and Cause of Burnout
The MMS has prioritized prior authorization reform as a means of combating physician stress and burnout. Concerns over burnout predate the COVID-19 pandemic, when the MMS Task Force on Physician Burnout was created jointly with the Massachusetts Health & Hospital Association in 2019, producing the landmark report, “A Crisis in Health Care: A Call to Action on Physician Burnout”
with Harvard’s T.H. Chan School of Public Health and Global Health Institute, followed by a 2021 update.
The more recent MMS report “Supporting MMS Physicians’ Well-Being Report: Recommendations to Address the On-Going Crisis,”
based on a 2022 survey of MMS members, examined the effects of the COVID-19 pandemic on physician well-being. The report’s findings are troubling. Where the years prior to COVID-19 saw a reduction in rates of physician burnout, the pandemic, with its vice-like combination of intensity and staying power, reversed the trend. The report found that an astounding 55 percent of respondents reported experiencing symptoms of burnout. The data
and insights identify the key drivers of work-related stress across demographics. Importantly, the report provides recommendations for reducing stressors and improving the work environment.
The largest category of stressors identified by physicians as contributing to burnout was administrative burdens, with prior authorization singled out by 58 percent of physicians as a source of stress. Prior authorizations take up considerable physician
and staff effort, leaving less time dedicated to patient care. A 2022 American Medical Association prior authorization (PA) physician survey found that practices complete on average 45 PAs per week, requiring roughly two business days (14
hours) of work, and 35 percent of physicians hire staff to work exclusively on PAs. Additionally, 94 percent of physicians reported that PA delayed access to necessary care, and 33 percent reported that PA had led to a serious adverse event
for a patient.
Each Physician Can Be Heard, with Just a Few Clicks
It is essential that physician voices join the efforts of the MMS, our coalition partners, and legislative champions to push the proposed reform legislation forward. The perspective of those who serve on the front lines of health care delivery carries
great weight with elected officials and policymakers, who need to hear your voices and be informed by your experience, your expertise, and your patients’ stories. Physicians are the best advocates and the Commonwealth’s best resource for driving
informed policy, legislation, and regulations related to health care.
Physicians needn’t be political experts to make an impact. MMS advocacy tools and campaigns make it quick and easy for physicians’ voices to be heard. The MMS encourages members to join our campaign to support prior authorization reform and make an impact
with just a few clicks. The legislature has already received more than 600 messages from physicians in support of prior authorization reform. Add your voice today!
Take Action Now — Make Your Voice Heard!
Let your state lawmakers know your views.
Click here to urge legislators to support key prior authorization reforms.
