AMA: Prior authorization frustrations can lead patients to abandon treatment plans

A survey of physicians conducted by the American Medical Association found a slew of complaints about the prior authorization (PA) process, with doctors saying it’s a burden on their practices, delays care for patients, worsens outcomes and even leads to patients abandoning their recommended course of treatment.

From the sample of 1,000 practicing physicians—40 percent of them in primary care practices—there was plenty of agreement that the current PA process isn’t working:

·         92 percent said PA has a negative impact on clinical outcomes for patients.

·         84 percent said the PA burden for their practice is “high or extremely high.”

·         86 percent said PA burdens have gotten worse over the past five years.

·         92 percent said the PA process can delay access to necessary care.

Quantifying the burden, 64 percent of respondents said they wait, on average, at least one business day for a decision on a PA request from insurers. Of that segment, 30 percent reported waiting at least three business days. Only 28 percent said they typically receive a response in less than a business day.

“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,” said AMA chair-elect Jack Resneck, Jr., MD. “In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.”

Resneck’s practice wouldn’t be alone in feeling the burden. Survey respondents were making an average of 29 PA requests per week, forcing staff members and physicians to spend an average of 14.6 hours per week on PA work. 34 percent of physicians said they have staff members whose sole job is working on PA requests.

This burden ends up trickling down to harming patients, according to the survey. Beyond the 92 percent of physicians who said PA has a negative impact on outcomes, 78 percent reported issues with the process can at least sometime lead patients to abandon the recommended course of treatment.

Smoothing out the PA process has gotten plenty of industry attention in recent years. The AMA itself has been a part of those efforts, partnering with other groups on a wish list for PA reform in 2017 and announcing a project with insurance giant Anthem to find ways to streamline or even get rid of “low-value” PA requirements.