Prior Authorizations Getting No Love From Physicians

by Clive Riddle, February 7, 2019 

Let’s examine something widely unloved, as we find ourselves just one week from that day of love known as Valentine’s Day, 

In the 1980’s and 90’s, managed care was largely perceived by physicians as a vehicle running on two unpopular characteristics: capitation and prior authorizations. Two decades into the new century, managed care is much more nuanced. But both characteristics have evolved and survived in various forms. 

And physicians still don’t love prior authorizations. Just ask the AMA, who just released survey results on this topic. AMA findings of physicians responses included: 

• 91% say that prior authorizations programs have a negative impact on patient clinical outcomes.
• 65% report waiting at least one business day for prior authorization decisions from insurers 
• 26% said they wait three business days or longer for decisions
• 91% said the prior authorization process delays patient access to necessary care
• 75% report that prior authorization can at least sometimes lead to patients abandoning a recommended course of treatment.
• 86% said the burdens associated with prior authorization were high or extremely high
• 88% 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
• These weekly authorizations take 14.9 hours of physician and staff time to complete.
• 36% employ staff members who work exclusively on tasks associated with prior authorization 

The AMA reports that “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 outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.