AMA advocates for strategies that drive telehealth access, offer premium grace periods, and address prior authorizations to promote patient care access.
State legislators, governors, and state health policymakers need to address telehealth access, health payer grace periods, and prior authorizations as part of their efforts to maintain patient access to care during and after the coronavirus, according to letters sent from the American Medical Association.
The letters, addressed to the National Governor’s Association, National Association of Insurance Commissioners, and National Council of Insurance Legislators, asserted that there are many actions necessary on the state level to preserve patient care access.
“As state leaders continue to debate how best and responsibly to address the myriad health care and health insurance issues that this pandemic provokes, the AMA urges strong consideration be given to the impact that such policy changes will have on patients’ immediate and long-term access to their physicians,” wrote AMA CEO and Executive Vice President James L. Madara, MD.
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“During this pandemic, policies that establish or fail to remove roadblocks between patients and their physicians threaten continuity of care or access to care in the near term,” he continued. “Moreover, policies that place financial burdens or cost-shift onto already strained practices threaten physicians’ ability to keep their doors open for their patients after this emergency is over.”
Foremost, Madara advocated for access to care through telehealth.
Telemedicine has been a patient care access boon during the coronavirus. As healthcare entities work to promote social distancing, telehealth has given patients and providers the opportunity to hold a care encounter from a safe distance. This is especially important for chronic disease management patients and providers avoiding contracting COVID-19 themselves.
Medicare has expanded telehealth reimbursement options and eradicated many interstate telehealth licensure laws. AMA encourages state governors to adopt the same practices, and moreover implored states to create systems that allow patients to see their specific physicians over telehealth.
For example, some healthcare payer telehealth policies may prevent providers who traditionally offer in-person care from participating in telehealth. This is of great need right now, as providers work to see non-COVID patients over telehealth to drive continuity of care. Additionally, some state policies are still limiting interstate telehealth access. This is seen when a provider treats patients along a state border. That patient may not be able to see her own provider over telehealth.
“The AMA, therefore, urges policymakers to prevent insurers from limiting who in their provider networks is able to provide telemedicine and to temporarily allow out-of-state physicians to provide telemedicine across state lines,” Madara wrote.
AMA also urged state policymakers to establish healthcare payer coverage grace periods.
Job loss is rampant in the US. In just three weeks, some 17 million individuals filed for unemployment, according to April figures from the Department of Labor. And with insurance coverage largely tied to employment, this is causing significant alarm for both patients and providers who rely on insurers to cover much of the cost of healthcare.
Although many states have both instituted policies that let some patients keep their group insurance despite job loss, furlough, or a reduction in hours, and implemented grace periods when premiums are not paid in time, there are some flaws in these plans, AMA said.
“Unfortunately, some of these policies permit insurers to pend claims during a grace period and eventually deny claims if coverage is cancelled,” the organization wrote.
These policies essentially shift cost burden onto patients and providers, two parties the AMA said are unable to absorb costs right now. Ultimately, the policies could act as disincentives for patients to access care and for providers to issue the care.
“The AMA, therefore, urges the adoption of grace periods and other continuity of coverage policies during this national emergency that relieve patients and physicians of financial risk associated with delayed payment or nonpayment of premiums,” the AMA implored.
Finally, AMA touched on alleviating certain administrative burdens that delay or impede care access. Notably, prior authorizations can keep patients from getting the treatment they need in a timely manner.
Prior authorization refers to the practice of clinicians submitting an approval to a health insurer to obtain a certain medication or treatment for a patient in order to receive payer coverage. AMA has long advocated for a streamlining of this process, which the organization has previously said can delay patient care for 91 percent of doctors.
“While the AMA normally works to reduce these barriers, under these exceptional circumstances, the AMA feels it is important to suspend them all together,” AMA wrote in this most recent letter. “For example, it seems unfathomable that at this moment, our health care system is still allowing prior authorization requirements to interfere in the provision of care, cause patients to make multiple trips to the pharmacy, delay transfers out of hospital settings, and pull valuable resources away from patient care.”
AMA also said prior authorization obtained for non-essential surgeries and procedures postponed during the coronavirus outbreak should remain valid.
“The AMA strongly urges policymakers to take immediate steps to prevent insurers’ administrative requirements from delaying care and payment and undercutting practice resources,” the group emphasized.
Ultimately, these measures are targeted at preserving patient access to care during and after the coronavirus pandemic. While the federal government has made overtures to maintain care access, there are some levers that are only accessible for state policymakers that AMA said need to be pulled.
“Governors have a critical role to play during this pandemic and the AMA stands ready to work with NGA and its member Governors to ensure that we emerge from this extraordinary time with a high-functioning, patient-centric health care system,” Madara concluded.
Source: PatientEngagement HIT