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Almost all surveyed physicians agree that prior authorizations required by insurers negatively affect the quality of care patients receive, according to a new American Medical Association (AMA) report. Ninety-two percent of surveyed physicians say prior authorizations get in the way of proper patient care, the group reports.
Prior authorization programs required by health insurance companies make it harder to prescribe an increasing number of medications or medical services, said AMA Chair-elect Jack Resneck Jr., MD. It’s not that insurers are denying the requests too often, he said, but rather the process of submitting documentation and justifying the physician’s plan of care is onerous.
“In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls, and bureaucratic battles that can delay or disrupt a patient’s access to vital care,” Resneck said in a statement announcing the survey results. “In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.”
The AMA surveyed 1,000 physicians, and 64% reported waiting at least one business day for prior authorization decisions from insurers. Thirty percent said they wait three business days or longer.
Those wait times are more than just a hassle, according to the AMA, with 92% of surveyed physicians saying the prior authorization process delays patient access to necessary care and 78% reporting that prior authorization can sometimes, often, or always lead to patients abandoning a recommended course of treatment.
“In addition, a significant majority of physicians (84%) said the burdens associated with prior authorization were high or extremely high, and a vast majority of physicians (86%) believe burdens associated with prior authorization have increased during the past five years,” the report stated. “The survey findings show 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 with the administrative burden, about a third of physicians (34%) rely on staff members who work exclusively on the data entry and other manual tasks associated with prior authorization.”
Resneck said the AMA survey illustrates a critical need to change the prior authorization system. In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association, and Medical Group Management Association in a Consensus Statement that, according to AMA’s website, “[outlined] their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.”
Financial Disclosure: Author Greg Freeman, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Jill Winkler, Editorial Group Manager Terrey L. Hatcher, and Consulting Editor Patrice Spath report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.