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News

Monday Rx: Pre-Authorization, Pandemic, Solutions Portal, Garfield Medical Center, Hispanic Heritage Month and Events

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Pre-Authorization Update

A bill that will reform prior authorization for Medicare managed care plans has unanimously passed out of the U.S. House of Representatives on a voice vote. The legislation – the Improving Seniors’ Timely Access to Care Act of 2022 (HR 3173) – provides comprehensive reform of the Medicare Advantage prior authorization process by streamlining the health plan bureaucracy to help Medicare patients get the care they need – when they need it.

CMA strongly supports this bill and is working to pass the bill before Congress adjourns in December. CMA thanks the California Members of Congress for moving the bill, and we urge the Senate to act swiftly to get it across the finish line.

“CMA applauds the bipartisan support for this important legislation, which will ensure that quality patient care remains the top priority – not the corporate bottom line,” says CMA President Robert E. Wailes, M.D. “Insurance company prior authorization red tape undermines health care outcomes by placing unnecessary obstacles to patients getting the care they need when they need it.”

Prior authorization requirements can be challenging for patients, creating barriers to care and increasing administrative burdens for physicians who must spend time and resources to get approvals as insurance companies design and administer increasingly complex prior authorization systems.

Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted in an attempt to increase health insurer profits. In a 2021 AMA survey, 93% of physicians reported care delays due to unnecessary prior authorization requirements. Specifically, 90% of physicians said that prior authorizations had a negative impact on patient clinical outcomes, with 34% of physicians reporting that prior authorization led to serious adverse events for a patient in their care, such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death. Moreover, physicians and their staff spend nearly two days per week on administratively burdensome prior authorizations instead of spending more time with patients.

A recent U.S. Department of Health and Human Services-Office of Inspector General report found that Medicare Advantage plans inappropriately deny necessary care for tens of thousands of patients annually.

HR 3173 will streamline Medicare Advantage prior authorization for routinely approved services, ensure plans adhere to evidence-based guidelines developed by physicians, mandate public reporting of prior authorization decisions and timeframes, and implement an electronic process to reduce physician administrative burdens.

Is the Pandemic Over?

President Biden said in a 60 Minutes interview Sunday that the COVID-19 pandemic is a thing of the past.

"The pandemic is over," he said. "We still have a problem with COVID. We're still doing a lot of work on it. But the pandemic is over. If you notice, no one's wearing masks. Everybody seems to be in pretty good shape, and so I think it's changing, and I think [the Detroit auto show resuming after three years] is a perfect example of it."

His remarks came as Biden's own administration seeks an additional $22.4 billion from Congress to keep funding the fight against COVID and as the United States continues to see hundreds of related deaths every day.

But is it still a pandemic? The National Institutes of Health defines the term as "an epidemic of disease, or other health condition, that occurs over a widespread area (multiple countries or continents) and usually affects a sizable part of the population."

Globally, there have been about 612 million cases of coronavirus. The number of new daily cases peaked in January for many countries, including the U.S. (806,987), France (366,554), and India (311,982), according to Our World in Data, an international organization of scientists.

Locally, over the weekend, over 1900 cases, 669 hospitalizations, and 16 deaths were reported.  So, is it over?


LACMA Solutions Portal and Marketplace Update

After launching the new LACMA Solutions Portal and Marketplace featuring over 100 solutions for medical practices, the site has generated almost 1,600 page views, more than 700 users, and only 15 registrations.  We will continue to share the latest news on the portals since members asked for more resources, added convenience, and mobile-friendly content.

Visit the Portal



Welcome, Garfield Medical Center and Allied Pacific IPA!

We are pleased to announce our new three-year signed agreement with Garfield Medical Center and Allied Pacific IPA. Huge thanks to Dr. Ken Sim for his leadership and support in securing this partnership. We look forward to supporting these physicians and engaging in ongoing activities, leadership opportunities and related efforts.


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Happy Hispanic Heritage Month!

We celebrate and honor the history, culture and contribution of American citizens with heritage from Spain, the Caribbean, Mexico, and Central and South America. This year’s theme is around building prosperous and healthy communities through jobs, the economy, climate, education, mental health, wellness and Investing.


 

Date: Thursday, October 6, 2022

Time: 5:30 PM - 6:00 PM

Location: Online

Defeat Burnout and Boost Retention Within Your Healthcare Facility

This webinar will focus on how to make administrative work easier for staff by improving systems and processes to reduce their workload long term.

 What you can expect to learn:

  • Why onboarding is crucial to success, and how to optimize it for staff retention
  • How modernizing your administrative procedures can reduce stress and burnout
  • Why “set-and-forget” systems improve work life for employees and help create a happier, more productive workplace
  • And more!
       Register

Date: Friday, October 21, 2022

Time: 2:00 PM - 4:00 PM

Location: Marriott LA LIVE, Diamond Salon 10

Understanding the Climate Health Crisis & How Californian Physicians Can Make an Impact

This will be an engaging two-part panel discussion that will explore the health impacts of climate change in California and the opportunities for California's physicians to advance policy-level climate solutions with enormous public health co-benefits. Sponsored by Climate Health Now and the California Foundation on the Environment and the Economy (CFEE) in coordination with CMA.

Please note: This event is available to attend either in-person or virtually via Zoom. During registration, please choose the registration option for how you intend to view this discussion.

Register

10th Annual Los Angeles Healthcare Awards

Honoring Healthcare Heroes

Join us as we recognize the 2022 honorees! This year’s 10th Annual LA Healthcare Awards is set to take place on November 4th at the Four Seasons Hotel Los Angeles at Beverly Hills. 

This is an extraordinary opportunity to celebrate and honor the incredible healthcare heroes who have selflessly demonstrated their dedication to the health and safety of the community. 

We invite you to join us as we recognize these healthcare heroes.  In addition, proceeds from the event support medical students who come from disadvantaged backgrounds and want to return and give back to their communities. Learn more about the honorees and event here

Purchase Your Ticket

 

 

#MondayMessage

"Helping others is like helping yourself."

Gustavo Friederichsen

Chief Executive Officer

Los Angeles County Medical Association

“If it matters to our LACMA members, it matters to me.”

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