Washington, D.C. – Congressman Michael C. Burgess, M.D. (R-TX) drafted an oped for Modern Healthcare's the 117th Congress: What's Ailing Healthcare in America describing his legislation to streamline prior authorization process.

'Gold card' approach streamlines burdensome prior authorization
By Congressman Michael C. Burgess, M.D. 
Modern Healthcare
September 20, 2022
Read full oped here.

Throughout my nearly three decades practicing medicine and serving two decades in Congress, I have heard numerous stories from physicians on the negative consequences of prior authorizations. This system creates unnecessary administrative hassles and complicates care plans for American patients. Although prior authorization was established to prevent fraud and abuse, it has turned into a process that has removed value and efficiency from a physicians practice as well as America’s overall health care system.

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Inspired by the Texas law, I introduced H.R. 7995 or the GOLD Card Act of 2022. This legislation would exempt providers, who received approval for 90% of their requests in the last 12 months, from prior authorization delays for Medicare Advantage beneficiaries. Additionally, the GOLD Card Act would allow physicians to appeal an attempt by a Medicare Advantage plan to rescind the exemption.

The concept of rewarding high performance is not new to health care. One of the core principles of “value-based care” is that providers should be rewarded for the quality of care that they provide. Therefore, adopting a gold card policy would allow our health care system to transition towards a value based care system.

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Texas and West Virginia are the only two states that have fully adopted gold carding policy, and at least five other states are interested in considering a gold card law. A recent study has concluded that 99% of Medicare Advantage enrollees are in plans that require prior authorizations. Recognizing that prior authorizations affect a significant portion of patients across the country, fixing this process is a critical component of streamlining efficiency and further encouraging value in our health care system.