March 02, 2021
Area(s) of Interest: Advocacy
The California Medical Association (CMA) is sponsoring a legislative effort to reduce administrative burdens in physician practices, so physicians can spend less time on paperwork and billing and more time dedicated to patient care.
Senate Bill (SB) 250 introduced by Senator Richard Pan, M.D., will reduce administrative burdens by reforming prior authorization and billing processes. As it stands, health plans already collect all the data needed to streamline the prior authorization process in their current utilization review system. The bill would relieve physicians from repetitively submitting prior authorizations for a set period of time, with a review at the end of that period to determine if that physician may continue to be exempt from prior authorization requirements. The bill would also streamline the billing process for physicians in hospital settings by requiring payors to collect enrollee cost-sharing amounts directly (including deductibles) – based on the agreements they make with their enrollees – freeing physicians from having to act as collectors, and, instead, allowing them to provide quality, coordinated care to their patients.
Physicians are spending increasing quantities of time filing paperwork, fighting with health plans and inputting redundant information into their electronic health records (EHR) instead of spending time with their patients. These administrative burdens cost time, money and other resources that could be better spent coordinating care for patients with chronic and/ or complex conditions or seeing more patients.
In a 2019 physician survey, the American Medical Association (AMA) found that, on average, providers complete 32 prior authorizations per week; taking nearly 2 working days out of the week to complete. Burdensome prior authorization processes also contribute to more adverse events, especially because they can result in treatment delays. In a follow-up AMA physician survey, 91 percent of physicians said that prior authorizations interfere with continuity of care for patients and have a negative impact on clinical outcomes.
The COVID-19 pandemic will have a lasting impact on the health of our communities. SB 250 will help to ensure that patients receive the care they need in a timely and efficient manner.