SHM Supports the Improving Seniors' Timely Access to Care Act

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The Honorable Suzan DelBene
U.S. House of Representatives
2330 Rayburn House Office Building
Washington, DC 20515

The Honorable Ami Bera
U.S. House of Representatives
1727 Longworth House Building
Washington, DC 20515

The Honorable Mike Kelly
U.S. House of Representatives
1707 Longworth House Office
Building Washington, DC 20515

The Honorable Larry Bucshon
U.S. House of Representatives
2313 Rayburn House of Representatives
Washington, DC 20515

Dear Representatives DelBene, Kelly, Bera, and Bucshon,

The Society of Hospital Medicine (SHM), representing the nation’s hospitalists, is writing to offer our support for the reintroduction of the Improving Seniors’ Timely Access to Care Act (H.R. 3173). This legislation will help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage (MA) program.

Hospitalists are front-line physicians in America’s acute care hospitals and focus on the general medical care of hospitalized patients. As a result, our members have been on the frontlines of the COVID-19 pandemic caring for patients. Hospitalists have been caring for high volumes of patients under extremely stressful and taxing situations throughout the pandemic, and the excessive administrative burdens related to prior authorization under MA plans waste time and resources that could be better utilized providing direct care to patients.

Many hospitalists report that prior authorization policies in MA plans result in delays of care, oftentimes among the most fragile patients and those requiring post-discharge care. Patient experiences include unnecessary waits for admission to skilled nursing facilities (SNFs) or rehab facilities and delayed discharges from the hospital while waiting for medication approvals. These delays prevent timely and safe transitions of care and exacerbates hospital access and capacity issues for other patients. This is a waste of clinician and hospital staff time and resources, and in many cases, adds unnecessary impediments to the standard of care for common conditions.

This legislation will help improve efficiency, transparency, and accountability of the prior authorization process in Medicare Advantage plans. Nearly a third of all Medicare beneficiaries are enrolled in Medicare Advantage plans, and of those, four out of five enrollees are in plans that require prior authorization for some services.1 As enrollment in these plans increases, we must ensure that clinicians are not saddled with increasingly excessive administrative burden and that patients are able to access the care or medications they need in a timely manner.

This legislation will help streamline the Medicare Advantage program and ensure resources are properly utilized to provide beneficiaries with high quality medical care. By creating more transparency and accountability, the Improving Seniors' Timely Access to Care Act would prioritize the needs of patients and reduce time-consuming prior authorization interactions between clinicians and MA plans. SHM is pleased to support this legislation and stands ready to help support its passage.

Sincerely, 
Jerome C. Siy, MD, MHA, SFHM
President, Society of Hospital Medicine