On April 23, the Wisconsin Hospital Association hosted the Centers for Medicaid and Medicare Services' (CMS) Principal Deputy Administrator and Chief Operating Officer Jonathan Blum as well as other staff from his leadership team and the Office of Burden Reduction.
Joining the conversation were SSM Wisconsin Regional President Sue Anderson, SSM Health St. Mary's Madison Hospital President Eric Thornton, Marshfield Clinic Health System Chief Information Officer Jeri Koester, Wisconsin Primary Health Care Association CEO Stephanie Harrison and COO Lynsey Ray, and WHA General Counsel Matthew Stanford and Vice President of Federal and State Relations Jon Hoelter.
WHA staff, hospital leaders and CMS reps at WHA’s headquarters in Madison April 24, 2024.
The discussion delved into the challenges prior authorization creates for health care providers in terms of both delaying payment and creating an enormous bureaucratic burden on practitioners. CMS officials said they are exploring how to best alleviate the burden on practitioners and wondered what types of strategies would be most effective.
Health care leaders agreed that reducing the volume of prior authorizations required for health care procedures that are straightforward and nearly universally approved would be one place to start. Another idea would be to provide more standardization among prior authorization policies so it is less of a maze for providers to navigate.
Participants also expressed worry that the extensive amount of time practitioners spend in patient medical records is mainly driven by prior authorization requirements, and that it greatly detracts from the work of clinicians who are supposed to be focusing on providing patient care, exacerbating a workforce shortage and creating patient bottlenecks.
In addition to the discussion on prior authorization, the conversation also covered burden reduction ideas in the areas of:
- CMS quality reporting programs
- Insurer credentialing
- Cybersecurity
- Post-acute care bottlenecks backing up hospitals
CMS officials said they intend to use the discussion to inform future projects they are pursuing in the areas of burden reduction.