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91% of Docs Say Prior Authorization Delays Patient Care Access

Prior authorization requirements cause patient care access delays, which in turn can hamper care quality, an AMA survey shows.

prior authorization

Source: Thinkstock

By Sara Heath

- Prior authorizations are leaving patients waiting up to three days or longer to receive certain treatments, causing critical patient care access delays and potential adverse patient safety events, according to a new survey from the American Medical Association.

Prior authorization requirements mandate physicians or hospitals submit a formal request to access a certain medication. Health plans implement prior authorization requests as a cost-cutting strategy, ensuring a patient genuinely needs access to such a high-cost medication.

But many healthcare professionals, including many represented by the AMA, say prior authorizations get in the way of patient care access and quality care.

“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care,” AMA Chair Jack Resneck, Jr, MD, said in a statement. “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality health care they need.”

Twenty-eight percent of the survey’s 1,000 physician respondents said prior authorization requirements have led to serious or life-threatening health events. Ninety-percent of respondents said prior authorization has negative consequences for patient care quality.

Patient harm at the hands of a prior authorization requirement likely stems from delays in care access. Ninety-one percent of physicians said prior authorization delays patient care access. Sixty-five percent said they have had to wait at least one business day to hear back from an insurer about a prior authorization decision. Twenty-six percent said they have had to wait at least three business days.

Prior authorizations are causing more than just care access delays. They may also be leading to treatment non-adherence, the survey revealed. Seventy-five percent of physicians said prior authorization delays can cause patients to abandon a certain treatment path at least some of the time.

What’s more, prior authorizations are putting stress on the organization administration staff, the AMA survey continued.

Eighty-six percent of physicians said prior authorizations cause burdens on their already crowded clinical workloads. Eighty-eight percent said these demands have grown in the past five years.

To put that into context, each care facility completes an average of 31 prior authorizations per physician per week. This totals to two business days (14.9 hours) worth of work for physicians and practice administrators.

Thirty-six percent of physicians said they have hired staff exclusively to manage prior authorizations.

These results reflect those from a similar survey AMA administered last year. The March 2018 survey revealed that 92 percent of physicians see patient care access delays because of prior authorization rules.

Physicians responding to last year’s survey saw similar wait times for prior authorization forms, reflecting little improvement in this area. Two-thirds of providers waited at least one day to hear about after submitting prior authorizations. About 30 percent of providers said prior authorizations can take up to three business days.

These results come even as AMA and other medical trade associations advocate against cumbersome prior authorization regulations. Although AMA and its partners have acknowledged the role that prior authorizations and other cost-cutting strategies can have on overall health spending, more must be done to address patient care access barriers.

AMA has previously called for changes in prior authorization rules. In 2017, the organization, alongside other industry leaders, supported prior authorization reforms. Specifically, the groups wanted to address clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency, and treatment alternatives in prior authorizations.

At the start of this year, AMA also advocated for eliminating prior authorization requirements for patients seeking medication assisted treatment (MAT) for substance use disorder (SUD). MAT is a clinically-proven treatment for opioid misuse, but prior authorizations keep patients from easily accessing it.

“The AMA is committed to attacking the dysfunction in health care by removing the obstacles and burdens that interfere with patient care,” Resneck said in response to this year’s survey. “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.”

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