Rep. Fischbach Questions Impact of Prior Authorization on Rural Healthcare

Prior Authorization's Impact on Rural Facilities

• 🎯 Prior authorization policies disproportionately affect rural areas, particularly concerning delays for skilled nursing care.
• 🏥 In rural communities, where residents may live further from hospitals, there's a higher utilization of skilled nursing facilities, making these delays more impactful.
• ⏳ Delays in approving post-acute care lead to longer hospital stays, affecting direct patient care as hospitals are not ideal for recovery.
• 📈 These delays also clog hospital systems, reducing capacity and preventing the transfer of patients needing higher levels of care from rural to tertiary facilities.
• 💰 Extended hospital stays due to these delays significantly increase healthcare costs.

Effectiveness of Federal Streamlining Efforts

• 📉 Despite federal efforts to streamline prior authorization, there has been no discernible positive impact on the ground.
• ⚠️ The trend shows an escalation in the number of denials and delays year-over-year, indicating these efforts have not yielded meaningful improvements.

Impactful Supplemental Benefits in Rural Areas

• 🚗 Transportation is highlighted as a critical, acute issue for rural beneficiaries, impacting their ability to access care and be with loved ones.
• 🦷 While health club benefits are underutilized, dental and vision plans are broadly utilized and provide a sense of commercial insurance.
• ✅ Dental health is recognized as being intrinsically tied to overall medical health, making dental benefits particularly impactful.