Survey finds prior authorization hurdles have led to serious adverse events

February 15, 2019
Area(s) of Interest: Payor Issues and Reimbursement Access to Care Advocacy 

More than one-quarter of physicians (28 percent) report the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening events for their patients, according to a new survey by the American Medical Association (AMA).

The survey of 1,000 practicing physicians found that prior authorization continues to have a distressing impact on both patients and physician practices. Despite widespread calls for meaningful reform from the California Medical Association (CMA), AMA and others in organized medicine over the last two years, the survey illustrates that prior authorization programs and existing processes remain costly, inefficient, opaque and hazardous in some cases.

Critical physician concerns highlighted in the AMA survey include:

  • 91 percent say that prior authorizations programs have a negative impact on patient clinical outcomes.
  • 65 percent report waiting at least one business day for prior authorization decisions from insurers – and 26 percent said they wait three business days or longer.
  • 91 percent said that the prior authorization process delays patient access to necessary care, and 75 percent report that prior authorization can at least sometimes lead to patients abandoning a recommended course of treatment.
  • 86 percent said the burdens associated with prior authorization were high or extremely high, and 88 percent believe burdens associated with prior authorization have increased during the past five years.
  • Every week a medical practice completes an average of 31 prior authorization requirements per physician, which take the equivalent of nearly two business days (14.9 hours) of physician and staff time to complete.
  • To keep up with the administrative burden, 36 percent of physicians employ staff members who work exclusively on tasks associated with prior authorization.

“The AMA is committed to attacking the dysfunction in health care by removing the obstacles and burdens that interfere with patient care,” said Dr. Resneck. “To make the patient-physician relationship more valued than paperwork, the AMA has taken a leading role by creating collaborative solutions to right-size and streamline prior authorization and help patients access safe, timely, and affordable care, while reducing administrative burdens that pull physicians away from patient care.”

In January 2017, AMA urged industry-wide improvements in prior authorization programs to align with a set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. CMA and more than 100 other health care organizations have supported those principles.

CMA and AMA welcome the opportunity to work collaboratively with health plans and others to create a more transparent efficient, fair and appropriately targeted prior authorization process.


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