Nearly 50 health insurers, representing commercial, Medicare Advantage and managed Medicaid plans covering 257 million Americans, recently committed to simplifying and standardizing the prior authorization process, and ASC administrators are approaching the announcement with cautious optimism.
These participating payers have pledged to implement a standardized electronic prior authorization system by Jan. 1, 2027, with the goal of enabling real-time approval for at least 80% of electronic prior authorization requests by that date.
Melissa Rice, administrator at Loyola Ambulatory Surgery Center, part of Trinity Health, shared her perspective with Becker’s:
“Regarding the impact on our clinicians, patients and health system, we cautiously welcome these reforms as a potential means to alleviate administrative burdens that have long been a concern in healthcare delivery,” she said. “If effectively implemented, these changes could indeed ease the strain on our clinicians, allowing them to focus more on patient care rather than administrative processes.”
Prior authorization has long been a pain point for ambulatory surgery centers (ASCs) and physicians. According to a Medscape report, 61% of physicians said patients frequently abandon a recommended treatment due to prior authorization delays or denials.
Ms. Rice emphasized that the long-term impact depends heavily on the execution of the reforms.
“While optimistic about the intent behind these reforms, we remain vigilant and hopeful that they will lead to tangible improvements in efficiency and patient care,” she said. “We look forward to seeing how these developments unfold and are committed to engaging constructively in this dialogue.”
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