Mehmet Oz, head of the Centers for Medicare and Medicaid Services, unveiled a 29-member coalition Wednesday aimed at dismantling one of healthcare's most frustrating bureaucratic obstacles: the prior authorization process that forces doctors to jump through hoops before treating patients.
Speaking at Axios' Future of Health Summit, Oz said insurers had already begun moving toward streamlined procedures last summer. But providers remained the problem. "The payers, the insurance companies, have been playing ball. Guess who's not been playing ball until today? The providers," he told the audience.
The new coalition brings together insurers, hospital systems, and health records companies to overhaul how medical procedures get approved before treatment. The goal is to replace the current system, which often relies on faxes, phone calls, and paper shuffling, with electronic authorization that moves faster and burdens doctors less.
Oz has been vocal about the issue. Earlier this month, he wrote that it's time to "axe the fax, kill the clipboard, and put patients over paperwork" through digital prior authorization systems.
The administrative burden has become especially pronounced in Medicare Advantage plans, which are run by private insurers under federal contract. Unlike traditional Medicare, these plans frequently require prior authorization for drugs and procedures, creating delays that frustrate physicians and delay care. Traditional Medicare historically has not imposed these requirements on most services.
The effort comes as Medicare has begun testing AI-powered pre-treatment reviews for certain health services in select states to identify unnecessary care. The move has made some doctors nervous about how artificial intelligence will factor into treatment decisions.
Prior authorization has evolved into a major flashpoint in healthcare policy. Doctors say the process wastes time and money, keeps patients waiting, and sometimes forces them to appeal denials of medically necessary care. Insurers argue the reviews help control costs and prevent unnecessary procedures. The new coalition suggests both sides may be ready to find middle ground through modernization.
Author James Rodriguez: "Finally, someone's forcing insurers and hospitals to stop pretending the status quo works. This coalition either delivers real change or becomes another empty Washington promise."
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