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92% of Docs Say Prior Authorizations Negatively Impact Outcomes

In addition to impacting clinical outcomes, 86 percent of physicians reported an increase in prior authorizations in the past five years, an AMA survey showed.

Prior authorizations and administrative burden

Source: Thinkstock

By Jacqueline LaPointe

Physicians are reporting that prior authorizations are negatively affecting patient care, a new American Medical Association (AMA) survey of 1,000 physicians showed.

Ninety-two percent of primary care and specialty physicians who provide 20 or more hours of patient care a week said that prior authorizations have a negative impact on patient clinical outcomes.

Of those respondents, 61 percent said prior authorizations have a significant negative impact and 31 percent said the utilization management programs have a somewhat negative effect on clinical outcomes, such as patient care access and treatment adherence.

Approximately 92 percent of physicians said that prior authorizations delay patient access to care, and 78 percent reported that prior authorizations can sometimes, often, or always result in patients stopping a recommended course of treatment.

“Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” stated AMA Chair-Elect Jack Resneck Jr, MD.

“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,” he continued. “In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.”

The daily administrative burden caused by prior authorizations was also on the rise for the majority of physicians surveyed. About 86 percent of participants reported an increase in prior authorization burdens over the past five years, with over one-half (51 percent) of providers saying prior authorization burdens increased significantly.

On average, physician practices completed about 29 prior authorizations per physician every week, the survey found. The average practice handled about 15 medical services and almost 14 prescription prior authorizations a week per physician.

Practices dedicated 14.6 hours, or about two business days, each week to complete the prior authorization workload.

Physicians oftentimes must complete prior authorizations themselves. But physicians practices are starting to turn to their staff to complete the tasks associated with utilization management programs. About one-third (34 percent) of physicians have staff who devote their work time to prior authorizations.

With prior authorizations taking up a significant portion of time and resources, physicians are reporting that the burden is too high. Eighty-four percent of respondents stated that prior authorization burdens were high or extremely high.

The survey’s findings echoed the results of an MGMA report from June 2017. In the MGMA analysis, 86 percent of medical practice leaders reported that prior authorizations increased over the past year.

Practice leaders attributed the prior authorization increase to the growing number of procedures and prescription medications that needed an authorization.

Some providers in the report also pointed to the use of third-party companies by payers. The companies helped payers operate utilization management programs, but providers explained that the companies made “the process more time-consuming, forcing some practices to hire extra staff to keep up with the requests and subsequently affecting patient care and delaying treatments.”

Repetitive prior authorizations also added to provider burdens, the AMA survey showed. Approximately 79 percent of physicians said that they sometimes, often, or always have to repeat prior authorizations for prescription medications when a patient is stabilized on a treatment course for a chronic condition.

“The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care,” said Resneck. “In response, 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.”

The industry group joined 16 other healthcare associations last year to push prior authorization reform across the industry. The associations pushed for 21 prior authorization reforms that centered on five tenets of utilization management improvement. The tenets stated that prior authorizations should demonstrate clinical validity, support care continuity, promote healthcare transparency, increase timely access and administrative efficiency, and offer exemptions to reduce administrative burdens.

AMA and five other industry groups also pushed similar reforms earlier this year. The groups urged payers to reduce the number of providers subject to prior authorizations. Utilization management programs should reduce requirements for providers who demonstrate high care quality and have historically high approval rates, the groups argued.

The healthcare industry should also prioritize automated prior authorization processes, the groups continued.

While AMA continues to put forth prior authorization reforms, the industry group recently teamed up with Anthem to implement utilization management program improvements.

In light of the survey’s results, the industry group intends to partner with more health plans and other stakeholders to improve prior authorizations and reduce administrative burdens.


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