Prior Authorizations Create Administrative Burdens on Physicians

Prior authorizations can be a burden for physicians.The American Medical Association, or the AMA, conducted a 2017 survey finding that 90 percent of physicians agree that prior authorization programs negatively impact patient clinical outcomes.

The prior authorization process delays patient access to necessary care. The survey found that 78 percent of physicians believe that prior authorization can, “sometimes, often or always lead to patients abandoning a recommended course of treatment.” 

In addition, 84 percent of these same physicians said the burdens associated with prior authorization were high or extremely high, and nearly the same number of caregivers (86 percent) said burdens associated with prior authorization have increased during the past five years. Furthermore, the survey states that, “every week a medical practice completes an average of 29.1 prior authorization requirements per physician, which takes an average of 14.6 hours to process -- the equivalent of nearly two business days.” To keep up, 34 percent of physicians said they rely on staff who work exclusively on data entry and other manual tasks associated with prior authorization. 

In January of this year, the AMA, along with five other healthcare organizations, drafted a “Consensus Statement” outlining their commitment to industry improvements to prior authorization processes and patient-centered care. More than 100 other healthcare organizations have supported these initiatives.

Another primary complaint, according to an article by MedScape, is that insurers use prior authorization to make the process of providing medical services more difficult, requiring the treating doctor to submit documentation for the recommended treatment. AMA chair-elect, Jack Resneck Jr., M.D., has said that insurers eventually authorize most requests, but the unnecessary, lengthy administrative processes and recurring paperwork make for an administrative nightmare. “In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden."

"The revealing AMA survey examined the experiences of 1,000 patient care physicians, with nearly two-thirds (64 percent) reporting waiting at least one business day for prior authorization decisions from insurers," according to the article.

Additionally, Dr. Resneck says, “The AMA has taken a leading role in convening organizations representing, pharmacists, medical groups, hospitals, and health insurers to take positive collaborative steps aimed at improving prior authorization processes for patients’ medical treatments.”

In March 2018, the AMA and insurer Anthem announced a collaboration to identify opportunities to streamline prior-authorization requirements and implement policies to minimize delays in the continuity of care.

Scott Rupp's picture

Scott Rupp

Contributor

Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

comments powered by Disqus

Related Articles