Dive Brief:
- Physicians are broadly unconvinced that recent commitments from insurers to reform prior authorization will result in any meaningful difference to the practice, according to a new survey from the American Medical Association.
- The Trump administration last year secured voluntary pledges from major insurers to reform their prior authorization policies. But only 33% of 1,000 physicians surveyed by the powerful provider lobby said they believed those promises would make a meaningful difference for patients and physicians.
- Over 70% of physicians were also doubtful that insurers were sticking to their current promise to ensure care denials in prior authorization based on medical necessity are being supervised by a qualified and licensed clinician, according to the survey.
Dive Insight:
Physicians have long criticized prior authorization practices, a cost-control measure used by insurers to approve medical services before they’re received by patients.
Providers say the process disrupts care, exacerbates burnout, wastes administrative resources and detracts from the patient experience. Insurers argue that their policies are necessary to modulate rising healthcare spending.
The Trump administration waded into the debate last summer by securing a voluntary promise from insurers to streamline prior authorization processes in a bid to cut down on duplicate or cumbersome tasks and transition to more standardized policies. Major insurers like UnitedHealthcare, Cigna, Elevance, Aetna and Humana signed onto the pledge, which included a number of milestones to hit by 2027.
Insurers have given a steady stream of updates on their prior authorization commitments since last year, with major insurers saying last month they had cut 11% of prior authorizations since the initial pledge was announced.
More insurers led by insurance lobby groups AHIP and the Blue Cross Blue Shield Association then said they would align electronic data submissions requirements for some medical services commonly subject to prior authorization beginning on Jan. 1. Insurers say the requirements should help make prior authorization faster and move providers away from manual filing done by paperwork and fax.
Still, the AMA survey shows that physicians are skeptical of the pledge, and remain widely dissatisfied with prior authorization policies.
Over 90% of providers told the AMA that prior authorization delays access to necessary medical care and 94% said the policies somewhat or significantly increase physician burnout.
Physicians say prior authorizations have negatively impacted patient care, with 1 in 4 telling the AMA the policies led to a serious adverse event for a patient in their care, and almost 80% saying prior authorization can at least sometimes lead patients to abandon treatment.
Providers said in the survey that they’ve been burned before by prior authorization commitments, including a consensus agreement made between major provider groups and insurers in 2018 to improve prior authorization.
Many physicians in the survey said those provisions failed to materialize. For example, providers said the most common way they complete prior authorizations is by phone, even though both the 2018 and current pledges aimed to handle more requests electronically. Providers also say prior authorizations interfere with continuity of care, which the 2018 agreement was meant to address.
“Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” said AMA President Dr. Bobby Mukkamala in a statement. “Rebuilding trust will require sustained, transparent, and measurable action to streamline prior authorization and keep it clinically focused and patient-centered. Anything less risks reinforcing the skepticism these pledges were meant to address.”
Insurers say they’re holding to their promises, and that the insurance industry is on track to meet its prior authorization milestone commitments on time, according to AHIP spokesperson Chris Bond.
The multi-year commitments “will streamline prior authorization while maintaining patient safeguards for safety, quality and affordability,” he said.
“As more providers do away with error-prone manual processes and adopt electronic prior authorization, health plans’ standardized approach will mean faster answers, a more consistent experience and less friction for everyone,” Bond said.
On Wednesday, the CMS announced additional commitments from major providers, electronic health record vendors and health data exchanges to streamline prior authorization through the Trump administration’s health technology initiative. Health systems like Bon Secours Mercy Health, Cleveland Clinic and Froedtert ThedaCare joined in, along with EHRs like Epic and athenahealth. The organizations will work alongside insurers who already committed to the pledge last year.
