AHA asks federal agencies to ensure adequate oversight of commercial insurers to protect patient access to care
A new report and infographic
from the American Hospital Association (AHA) released today highlights
how some commercial health insurers apply policies that can cause
dangerous delays in care for patients, result in undue burden on health
care providers and add billions of dollars in unnecessary costs to the
health care system.
The
report, which includes results of surveys conducted by the AHA, found
78% of hospitals and health systems reported their experience working
with commercial insurers is getting worse, with fewer than 1% reporting
it was getting better. The AHA fielded the surveys in 2019 with more
than 200 hospitals responding and again between December 2021 and
February 2022 with 772 hospitals responding. While
some findings predate COVID-19, recent data reinforces challenges from
before the public health emergency that have persisted.
The
report focuses specifically on patient and hospital experiences with
prior authorization and payment delays, denials and appeals. Hospitals
and health systems report growing rates of delays and denials for
medically necessary care and that appeals frequently result in insurers
overturning their earlier decisions. This calls into question the
initial denials and the burden associated with challenging them. The
tactics highlighted can delay patient care and put even more strain on
an already overburdened workforce, with 95% of hospitals and health
systems reporting increases in staff time spent seeking prior
authorization approvals.
“These
survey results are stark evidence that some commercial health insurers
deny care while hospitals and health systems focus on providing care,”
said AHA President and CEO Rick Pollack. “Patients deserve
comprehensive health coverage with the protections they were promised
when they signed up. Congress and the Administration need to act now to
hold commercial insurers accountable for actions that delay patient
care, contribute to clinician burnout and workforce shortages, and
increase costs.”
The survey results echo findings
from a U.S. Department of Health and Human Services Office of Inspector
General report from earlier this year that raised serious concerns
about beneficiary access to care and inappropriate coverage and payment
denials in the Medicare Advantage program. Nearly half of Medicare
beneficiaries are enrolled in a private Medicare Advantage health plan,
and enrollment in these plans is growing at a rate of nearly 10% per
year, raising the importance of ensuring adequate oversight in the
program.
In a letter
sent to Health and Human Services Secretary Xavier Becerra and
Department of Labor Secretary Martin Walsh, the AHA stressed the
importance of comprehensive coverage for patients and urged the
Administration to take additional actions to ensure adequate oversight
of commercial health insurers.
The AHA report offers a number of solutions for policymakers to reduce
the risk and burden of certain commercial health insurer practices
while still enabling insurers to compete on quality, benefit package
design, provider networks and other important aspects of coverage.
These include streamlining prior authorization processes and increasing
oversight so that regulators can target specific inappropriate
behaviors.
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