AMA says prior authorizations increasing, interfering with care continuity
The number of prior authorization requirements has increased in the past five years and 85% of physicians say the practice interferes with continuity of care, according to a new survey from the American Medical Association.
Findings from the survey of 1,000 physicians released Tuesday found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization. Fewer than 10% said they contract with a health plan that allows programs that can exempt providers from the requirement.
Most prior authorizations are obtained by phone or fax, according to the report. Just over 20% of physicians said their EHRs allowed for electronic approvals, which can be more efficient.
AMA and groups like the American Academy of Family Physicians have argued that payers need to improve the prior authorization process. In a statement released with the survey findings, AMA charged insurance companies with a "year of foot-dragging and opposition" to prior authorization reforms.
A group of Michigan healthcare organizations came together and created Health Can't Wait to protest prior authorizations. Critics of the practice allege that requiring payers to approve certain services leads to delayed and disrupted care.
However, payers view prior authorizations as a vital cost control that limits unnecessary care. Prior authorizations also have their supporters in Washington. A Government Accountability Office report released in 2017 found that prior authorization in Medicare saved as much as $1.9 billion through March 2017. The Trump administration's proposed budget also includes expanded prior authorization measures for Medicare.
The #TrumpBudget includes 5+ new proposals to expand #PriorAuthorization in Medicare. #PriorAuth negatively impacts patient care and increases administrative costs. Who should decide what's best for patients: your doctor or the govt? #LetDocsDecide #MGMAAdvocacy #FixPriorAuth pic.twitter.com/cBdkDKURN2— Anders Gilberg (@AndersGilberg) March 11, 2019
However, providers complain that the process is burdensome and affects patient care. The American Academy of Family Physicians has called the practice family physicians' "number one administrative burden."
Though manual prior authorizations are considered cumbersome, electronic prior authorizations have shown to speed the process and save money. Automating prior authorizations reduces wait time for providers and patients and can lead to cost savings. The Council for Affordable Quality Healthcare estimated that electronic methods can save $6.84 per transaction.
Payers understand there is a problem with manual prior authorizations. America's Health Insurance Plans and the Blue Cross Blue Shield Association came together with the AMA, American Hospital Association, American Pharmacists Association and Medical Group Management Association. The groups released a "Consensus Statement on Improving the Prior Authorization Process" last year.
The groups agreed that reforms are needed. However, the latest AMA survey found that providers haven't seen an improvement yet. The findings echo a February AMA report that more than a quarter of physicians said prior authorizations lead to "serious or life-threatening events."
In a statement Tuesday, AMA President Barbara McAneny said prior authorizations can work against people seeking treatment for opioid use disorder and that can be deadly. "The AMA urges all health insurers to join with the medical community to enact vital legislation that is an important step in reversing the opioid epidemic," she said.
- American Medical Association Measuring progress in improving prior authorization