By October of next year, CMS wants to implement a newly proposed rule that would extend electronic PA (prior authorization) into drug coverage.

It will require FHIR-based APIs, faster decision timelines, and the ability for cleaner data exchange. It is being presented as a breakthrough.

I've been doing this long enough to recognize the difference between fixing a problem and managing it more smoothly.

Prior authorization costs the US healthcare system $35 billion a year. Physicians spend 13 hours a week on it. Patients abandon treatment because the process outlasts their ability to fight it. Sadly, this includes cancer patients as well. In fact, a systematic review published last year tied PA delays to measurable drops in cancer survival rates.

But what's the solution? Make the paperwork digital. That's not meant to come off dismissively... Interoperability matters. Electronic workflows reduce friction. Every minute saved on a PA request is a minute that can go back to saving a life! We have physicians spending 13 hours a week — 13 hours! — navigating a process that approves over 90% of what it reviews anyway. We now have patients abandoning chemotherapy mid-cycle because an algorithm decided the timing wasn't right. In a 2024 survey of more than 750 radiation oncologists, 7% reported that prior authorization had contributed to a patient's death.

But these things are true within a framework that remains fundamentally unchanged. One designed by and for an industry that has historically treated utilization management as a revenue strategy and nothing more. In 2022, Cigna physicians spent an average of 1.2 seconds reviewing each of the 300,000+ claims they denied. A practice that prompted AMA to call for federal oversight.

The conversation we aren't having loudly enough is the one about assumptions. About who built this system, what they built it to do, and whose interests it has always served. Administrative efficiency inside a structure that prioritizes margin over medicine will always produce administrative efficiency in service of margin.

The mindset shift required here is a moral one. It is the collective decision that a physician's clinical judgment should not require a payer's permission to act on. Because that very judgement was built over a decade of training and years of trial and error.

If you work in healthcare, ask yourself, "What will it take for me to stop accepting this as normal?

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Dr. Rafael Grossmann is a trauma surgeon, digital health innovator, and global keynote speaker focused on the intersection of technology and human-centered medicine. He speaks on AI in healthcare, physician burnout, and the future of patient care.