August 16, 2023
|The Honorable Michael Burgess, MD||The Honorable Vicente Gonzalez|
|U.S. House of Representatives||U.S. House of Representatives|
|2161 Rayburn HOB||154 Cannon HOB|
|Washington, D.C. 20515||Washington, D.C. 20515|
Dear Representatives Burgess and Gonzalez,
On behalf of our member medical group practices, the Medical Group Management Association (MGMA) appreciates your continued support for prior authorization reform and applauds the introduction of the GOLD CARD Act of 2023 (H.R. 4968). Prior authorization continues to result in unnecessary administrative burdens that adversely impact patients. We strongly support this commonsense legislation that would streamline and remove barriers to care. MGMA urges Congress to swiftly pass this critical bill.
With a membership of more than 60,000 medical practice administrators, executives, and leaders, MGMA represents more than 15,000 medical groups in which more than 350,000 physicians practice. These groups range from small private practices in rural areas to large regional and national health systems and cover the full spectrum of physician specialties and organizational forms.
Prior authorization continues to be a significant burden for both practices and patients, causing delays in patient care, adverse clinical outcomes, and increased paperwork and costs. In a recent MGMA survey, 82% of medical group practices rated prior authorization requirements as very or extremely burdensome, citing inconsistencies and constant changes in requirements. Additionally, 89% of physician practices cited an increase in prior authorizations over the previous year, while less than 1% reported a decrease.
In the wake of record inflation, staffing shortages, and across-the-board Medicare reimbursement cuts, 77% of medical group practices report redistributing staff to work on prior authorizations due to the increase in requests. Staff are often required to follow up with several different parties involved in the prior authorization process, including patients, pharmacies, and insurance plans. When it comes to prior authorization, practices should be in the driver’s seat of their patient’s care.