In response to an article, Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds, that appeared in the New York Times on April 28, 2022, AMRPA Chair Anthony Cuzzola submitted the following letter to the editors commending The Times for its coverage.
Re: Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
I commend the New York Times for highlighting the heartbreaking story of Holocaust survivor Mr. Kurt Pauker and the roadblocks he has and continues to face in trying to access medically necessary inpatient rehabilitation care. Unfortunately, as the Chair of the national trade association for inpatient rehabilitation providers, Mr. Pauker’s experience is one faced by our hospitals’ patients on a daily basis. All the worse, it’s also often the patients with the most complex underlying conditions, such as stroke or traumatic brain injury, that are denied care by Medicare Advantage plans.
The federal oversight report cited in the Times’ article calls long overdue attention to the “prior authorization” practices used by Medicare Advantage plans, which often serve as an egregious barrier to the care prescribed by the patients’ doctors. The unacceptable wait times, unqualified reviewers and inappropriate criteria regularly blocks patients’ access to their most appropriate treatment – due largely to plans’ financial motivations.
It’s also not just the individual patients that are harmed, either. The delays in receiving determinations mean that hospitals have to wait to discharge patients – consuming valuable resources when hospitals are already stretched thin due to the pandemic and labor challenges. In addition, any additional (and avoidable) care needs for patients like Mr. Pauker that result from suboptimal care will be paid for by the taxpayer through the Medicare program.
The good news is that policymakers have the authority to make changes, and AMRPA stands with hundreds of other provider groups in calling for commonsense reforms – such as more appropriate response timeframes and reviewer qualification standards. We are pleased to see the report urge this type of action from federal regulators. AMRPA applauds the Times for highlighting this issue facing patients and looks forward to helping enact policies that protect patients such as Mr. Pauker.
Chairman, AMRPA Board of Directors
Vice President, JFK Johnson Rehabilitation Institute, Hackensack Meridian Health
Posted April 29, 2022