'That's A Huge Problem': Mike Kelly Slams Long Waits For Medicare Advantage Authorizations

4 months ago

During a House Ways and Means Committee hearing before the Congressional recess, Rep. Mike Kelly (R-PA) asked Vice President of Clinical Quality and Population Health Officer at Avera Health Dr. David A. Basel, M.D. about long waits for Medicare authorizations.

Transcript

00:00I now recognize Mr. Kelly. Thank you, Mr. Chairman. Thank you all for being here today.

00:05I want to go back to not so much the political back and forth on it. I want to talk about the

00:10model that's in operation right now. So, look, the district that I'm in has one of the highest

00:18Medicare Advantage usages in the country, and we've long been a supporter of the program.

00:23However, the program has become increasingly costly and complicated for seniors.

00:27Constituents have described to me the countless stories of waiting weeks for approval for treatments

00:33that their doctors say they need immediately. Now, the reason I want to bring it up as a business

00:38is in the automobile business I'm in, we go through the same thing with warranty on both

00:43repair work and warranty work, and you wait and wait and wait for the authorization that

00:50whoever it is that bought that automobile brings it in to have work done on it, and you're waiting

00:54for somebody from the factory to go ahead and approve the work that needs to be done.

00:58We know what the work is that needs to be done, but we have to wait for the approval from somebody

01:03else to say, okay, go ahead and honor the warranty. Go ahead and honor the program that these folks

01:10have bought after the warranty runs out. But you wait and wait and wait for authorization.

01:16So, I mean, a lot of people say, don't compare this to cars and trucks. I'm talking about the ability

01:21to get up and do whatever you need to do every day and function. And if you're waiting for

01:25authorization to do something the technician knows needs to be done right now, that's a problem.

01:32That's a huge problem. So, Mr. Albany and I are working on a piece, and it's incredible because

01:38right now we have 220 co-sponsors on. This is on both sides of the aisle. We all recognize that

01:45there's a problem. And so what I want to do, I want to get, you're the techs, you're the people

01:50that are waiting on it. I'm a guy who's a dealer who I have three quarters of a million people relying

01:56on me to get them answers to whatever they think they have coming and say, you know what? Get

02:01something done. Get this fixed. So rather than take turns bashing about who's in the office at this time

02:07and who's doing, who's not doing their job. Just what could we do to make it easier?

02:14Dr. Boswell, if you would, if you would expand on this a little bit, because that's where I find

02:18out where the problem is. You shouldn't have to wait for things you already have coverage for.

02:21So a lot of this is streamlining the process. And so there's a lot of, a lot of proposals out

02:29there right now trying to increase electronically streamlining it, which is certainly would be

02:34welcome. I can even give you examples that I was asked informally beforehand, you know, are you

02:39against faxing in records or stuff? We've got payers that I would love to be 1970s era faxing

02:45things in because we have to call them up and verbally dictate the history and physical allowed

02:50into the phone to get it into the record right now. And so there's a lot of work from an efficiency

02:56standpoint. The other side of that is figuring out, you know, what are the appropriate ones that

03:02should be flagged? If we're overturning more than 70% of the denials, then there's a lot

03:07of unnecessary administrative overhead that goes into that. And there's got to be a better

03:10way of doing that.

03:12So, and Dr. Miller, you talk pretty much about the same thing, right? So codification is a

03:17huge problem in anybody that runs any business where you have to file a claim. In our case,

03:21you may have the wrong serial number, you may have the wrong operation number, you may have

03:24the wrong flat rate number that you're supposed to be charging to fix whatever it is that needs

03:28to be fixed. This is a huge problem. And anybody, and I'm talking now just as a business, okay?

03:34And I hear, well, there's different things about who struck John. Here's the problem. Here's

03:38the problem. It takes so much effort to put the right information in to get the approval

03:43on it. Things unnecessarily get held up. In my business, people are still making payment

03:49on our car or truck that they can't drive because we can't get authorization to go and do the warranty

03:54work in their car. This has become too complicated. And there's the number of mistakes that are

03:59made make it very difficult. I mean, part of what we call unproductive labor are the people

04:04that fill out all these forms that we get authorization for, get payment for. You face the same problem.

04:10I'd say this is an operational problem that the managed care industry needs to get behind

04:15in fixing. And it needs to fix it in conjunction with the hospital industry, with doctors and the

04:20electronic health records. My iPhone has auto-correct. It automatically summarizes iMessages. I could

04:27set up, you know, automatic deductions from my bank account. We could, you know, invest in

04:32my retirement account here from my phone. All of these things can be done in an automated

04:36simple fashion. We just need to implement those electronic tools and automation of process

04:42in care delivery. So that's something hospitals and doctors and plans need to sit down together

04:48and do it. I want to thank you all for being here today. It is a business model. At the

04:53end of the day, I know we're talking about people's health. That's critical. But these

04:57things are all fixable. With what we have available today to do this stuff, we just need to implement

05:02it and put it into effect. Thank you so much for being here today. You guys are incredible.

'That's A Huge Problem': Mike Kelly Slams Long Waits For Medicare Advantage Authorizations

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