LUGPA Supports Reforms to Prior Authorization

Chicago, IL, October 1, 2023 – LUGPA supports policies and regulations that protect cost-effective, timely and quality care for patients. Payor policies, such as prior authorization (PA), frequently delay treatment, limit patients’ access to care and ultimately, interfere with a physician’s ability to provide appropriate treatment for their patients. As Congress further reviews the Improving Seniors’ Timely Access to Care Act, we urge policymakers to consider the positive impact it could have on both the quality of care for patients and patient outcomes.

In a 2022 survey from the American Medical Association, 94 percent of physicians reported that PA causes delayed access to necessary care, and 80 percent reported that it can lead to abandoning their recommended course of treatment. Consequently, 33 percent of physicians report that PA has led to a serious adverse event for a patient in their care, some of which can be fatal.

Recently, Congress and the Centers for Medicare & Medicaid Services (CMS) have taken an interest in addressing these issues through much-needed reforms. In July, the House Ways and Means Committee passed the Improving Seniors’ Timely Access to Care Act, which would improve the PA process for Medicare Advantage. This passage from the Committee closely follows a bipartisan letter from Congress urging CMS to finalize a pending regulation which would streamline the PA process for federal health programs. The proposals from both Congress and CMS aim to reform PA through a variety of methods, including establishing an electronic process, creating time requirements to expedite the process, increasing transparency and ensuring that decisions come from evidence-based medical guidelines.

“As independent urologists, we know that prior authorization interferes with our ability to provide the best care for our patients,” said Evan Goldfischer, M.D., president of LUGPA. “This inefficient and burdensome process ultimately harms patients and physicians. In fact, on average, practices complete 45 PAs a week – taking up nearly two business days. However, the future of health care does not need to be this way; these negative outcomes can and should be prevented. Policymakers must reform prior authorization so that patients can access the life-saving care they need.”

Americans can contact their Congressional representatives and let them know they support policies that provide them with access to timely, cost-effective and quality health care. To find your Congressional representative, visit https://www.house.gov/representatives/find-your-representative.    

About LUGPA 

LUGPA is the only nonprofit urology trade association in the US. Since its founding in 2008, LUGPA has earned national recognition in the pursuit of its mission to preserve and advance the independent practice of urology while demonstrating quality and value to patients, vendors, third-party payors, legislators and regulatory agencies. The robust resources LUGPA provides help member groups to meet the challenges of independent practice in today's rapidly changing healthcare marketplace. For more information, visit www.lugpa.org 

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