Docs say prior authorizations harm clinical outcomes
- More than nine in 10 physicians in a new American Medical Association poll believe prior authorizations undermine patient clinical outcomes.
- The survey of 1,000 practicing physicians found that 65% wait at least one business day for prior authorization decisions from health plans, and 26% wait three business days or longer.
- The AMA is currently collaborating with Blue Cross Blue Shield Association and other major healthcare players on efforts to improve prior authorization processes.
Payers see prior authorization, which requires an extra layer of approval before paying for a treatment, as a powerful tool to prevent unnecessary care and control costs. But providers and patients find the practice a frustrating and time-consuming hurdle to getting needed therapies.
Last February, California and Colorado disclosed they were investigating Aetna's prior authorization practices after a former medical director claimed he didn't review medical records when making authorization decisions. Instead, he said, he relied on guidance from Aetna nurses who reviewed the information.
But despite frustration with the practice, prior authorization is not going away. A handful of Medicare prior authorization demonstration projects saved the government an estimated $1.1 billion to $1.9 billion between 2012 and 2017, according to a General Accountability Office report. The programs covered repetitive scheduled nonemergency ambulance services, home health services, certain mobility devices and nonemergency hyperbaric oxygen therapy. CMS also has a permanent program for certain durable medical equipment, prosthetics, orthotics and supplies.
Cost savings aside, AMA Chairman Jack Resneck said the survey "continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care."
The group said the survey points to the need for reform in prior authorization programs. Of the 1,000 respondents, 91% said the process delays patient access to necessary care, and 75% said it has led patients to discontinue a recommended treatment plan.
Prior authorization also adds to administrative burden, a major source of physician burnout. In the AMA survey, 86% of doctors ranked the burdens associated with prior authorization as "high" or "extremely high," with 88% saying they have grown over the past five years.
The survey shows physician practices complete on average 31 prior authorization requirements per doctor per week — consuming 14.9 hours of time, or nearly two business days. More than a third of physicians (36%) said they designate staff members to focus solely on dealing with prior authorization requests.
- American Medical Association 2018 AMA Prior Authorization (PA) Physician Survey