WASHINGTON — The Biden administration’s drug czar has a challenge for America’s doctors, especially members of the American Medical Association (AMA): help figure out the best way to treat substance use disorder (SUD) patients.
“While the Biden administration has improved access to care for millions of people with OUD [opioid use disorder], we’ve got a lot more work to do,” Rahul Gupta, MD, director of the White House Office of National Drug Control Policy, said Tuesday at the AMA’s National Advocacy Conference here. “This is where we need your help. We need more docs screening and case-finding for SUD across all subspecialties. We need more curriculum on SUD because I can tell you, if we’re not taught something, we’re not interested in it … and that has a lot of consequences.”
“We really need more folks across our profession to help figure out how to treat patients with SUD,” he continued. “I don’t think it’s any different than diabetes or hypertension or heart disease; it’s another thing we can do for our patients. And we can’t do that without your help. My ask is, let’s help ourselves build an addiction infrastructure that we need by becoming a part of it.”
A bigger workforce is also needed, Gupta said. “One of the things we’re working on is making sure we have the workforce of the future. We’ve got more providers, more loan repayment programs, minority fellowships, and other things we can do to get more providers into the country. We need the next generation of providers.”
Gupta concluded his remarks with a personal plea to his fellow AMA members. “I’ve been a member of the AMA since my first year of internship,” he said. “I’ve been president of my county medical society and state medical society … I know the power of organized medicine. When the AMA gets behind an idea, it changes hearts and it changes minds. And most importantly, you can help change this policy.”
Conference attendees also heard from Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, who emphasized her agency’s commitment to improving the lives of providers. “One of our top priorities has been to empower frontline clinicians to focus on providing direct care to their patients,” she said. “We’re really focused on tackling unnecessary burdens … [including] current challenges with the prior authorization process. We know and we are hearing that although prior authorization is really important to help ensure that medical care is appropriate, there are inefficiencies resulting in barriers for patients, providers, and payers.”
Hearing from AMA members about their prior authorization experiences, “I really felt a different level of understanding hearing some of the stories about people’s surgeries being delayed and people not getting the care that they need because of these processes,” she said. “It’s been really important to hear that feedback for us to really understand how our policies are affecting care on the ground and what we can do to address those … That is the CMS that we want to have — one where we are listening and really absorbing what’s happening on the ground.”
As a result of what agency officials have heard from physicians and other stakeholders, CMS is proposing changes to the prior authorization process in Medicare, Medicaid, and in plans purchased on the Affordable Care Act marketplaces, Brooks-LaSure said. “If it’s finalized, [our proposed rule] would shorten the timeframe for certain payers to respond to prior authorization requests, and it requires payers to provide reasons for denial, as well as promote healthcare data-sharing across providers, patients, and caregivers. This is something that’s really important to the administration.”
In addition, “we’re proposing new electronic standards for healthcare attachments and signatures,” she continued. “Currently, healthcare clinicians are often forced to fax or mail attachments like medical charts, x-rays, or notes, and spend hours trying to figure out what documentation is required for prior authorization. If this rule is finalized, the proposed electronic standards will promote more reliable communications and prevent avoidable delays in patient care.”
The agency is also “proposing significant changes to strengthen the rules of the road for prior authorization in Medicare Advantage plans, including improvements to ensure that people have timely consistent access to medically necessary care,” she added. “These revisions would ensure that Medicare Advantage enrollees have the same access to medically necessary care they would receive in traditional Medicare.”
The AMA is especially pleased with the proposed changes to prior authorization, AMA President Jack Resneck Jr., MD, said in an interview with MedPage Today, during which a press person was present. “This is one where we’re beginning to see real momentum and progress,” he noted. “We had the House, in overwhelming bipartisan fashion, pass a bill to address prior authorization overreaches by health plans and Medicare Advantage plans. We couldn’t quite get it across the finish line in the Senate because of a CBO [Congressional Budget Office] score issue, and we’re going back to work on that.”
Because of that House action, combined with the CMS proposed rule, “the physician community is feeling so heard on this issue, and feeling like their patients are heard,” Resneck said, adding that one likely reason for such successes is that everyone Resneck has talked to on Capitol Hill has had their own negative experience with prior authorization.
“When I go meet with the team at CMS or legislators on either side of the aisle … I don’t know anybody who hasn’t personally had themselves or a family member with the same infuriating experience of sitting down with a doctor, figuring out a diagnosis, talking about treatment options, side effects, settling on what they think is best, going to the pharmacy, and then getting the disappointment: ‘Actually your plan doesn’t cover this and it’s going to require weeks of fighting and fax machines and peer-to-peer phone calls with people who aren’t really peers,'” he said.
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