Prior Authorization Burdens Hindering Patient Care, AMA Survey Finds

March 20, 2018
Approximately 64 percent of physicians in a recent American Medical Association (AMA) survey said they wait at least one business day before getting a response from a health plan regarding a prior authorization (PA) decision.

Approximately 64 percent of physicians in a recent American Medical Association (AMA) survey said they wait at least one business day before getting a response from a health plan regarding a prior authorization (PA) decision.

The 27-question survey was given to 1,000 practicing physicians, according to AMA. About 30 percent of respondents said that they actually wait three business days or longer before getting a PA decision from the payer. As such, this lag often leads to care delays; 92 percent of survey respondents reported such delays in patient care.

What’s more, according to the survey, 78 percent of physicians said that PA can at least sometimes lead to treatment abandonment on the part of patients. And 92 percent of respondents said that this could lead to a negative impact on patient outcomes.

In January, a collaborative of healthcare organizations, including the AMA, the American Hospital Association (AHA), and the Medical Group Management Association (MGMA), released a joint statement calling for improved prior authorization procedures, including automating the process to improve transparency and efficiency. Along with these associations, the collaborative included the America’s Health Insurance Plans, Blue Cross Blue Shield Association and American Pharmacists Association.

According to a recent MGMA Stat poll, over 80 percent of respondents in that survey said they have seen an increase in prior authorization requirements from payers. “Meeting health plan proprietary authorization requirements consume significant time for both clinical and administrative personnel, diverting staff away from providing direct patient care, and costing practices countless dollars to administer,” Anders Gilberg, MGMA senior vice president, government affairs, said in a statement at the time. “Most importantly, the prior authorization process can result in delayed or denied patient care.”

As such, the groups contended that prior authorization is one of the most burdensome administrative requirements faced by medical group practices and the joint statement is an effort to solve some of the most pressing concerns associated with prior authorization. The joint statement focused on five areas: selective application of prior authorization; prior authorization program review and volume adjustment; transparency and communication regarding prior authorization; continuity of patient care; and automation to improve transparency and efficiency.

The group called for industry-wide adoption of electronic prior authorization transactions based on existing national standards, which has the potential to streamline and improve the process for all stakeholders.

To this end, the AMA survey data revealed that 84 percent of physician respondents said the burden association with PA for the physicians and staff in their practice is either “high or extremely high.” And 86 percent said that those PA-related burdens have increased over the last five years.

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