Prior Authorization Burden Still High Despite COVID Struggles

Most physicians still faced a high prior authorization burden despite treating a surge of positive COVID-19 cases this winter, the American Medical Association (AMA) reports.

In a survey of 1,000 practicing physicians between Nov. 23, 2020, and Dec. 14, 2020, AMA found that 85 percent of physicians described the burden associated with prior authorization as high or extremely high last year.

On average, practices completed 40 prior authorizations per physician a week, the survey showed. And those prior authorizations consumed two business days, or 16 hours, each week, on average.

About two in five physicians also had staff who work exclusively on prior authorization requests and follow-up, the survey found.

The burden associated with prior authorization was slightly down from last year’s survey when 85 percent of physicians described it as high or extremely high. Practices also had an average of 33 prior authorizations per physician per week and the average time prior authorizations took was 14.4 hours.

Despite the slight dip in burden, the prior authorization work in 2020 was also all being done in the backdrop of a global public health emergency, AMA pointed out.

Most physicians reported that prior authorization policy changes during the COVID-19 pandemic had limited reach and minimal lasting impact.

In the survey, 52 percent of physicians said payers never relaxed prior authorization requirements during the pandemic, while 17 percent said requirements were temporarily relaxed but are now back to normal.

Another 17 percent of physicians also said some prior authorization requirements are back to normal but others are still being relaxed because of COVID-19.

Just 1 percent of physicians faced relaxed requirements and had continued to see a reduced prior authorization burden by the end of 2020. Meanwhile, the remaining 14 percent of physicians did not know.

The findings point to a continued need for prior authorization reform, the AMA stated.

“By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care,” Susan R. Bailey, MD, president of the AMA, said in a press release.

An overwhelming majority of physicians (94 percent) reported at least some care delays associated with prior authorizations. About 79 percent of physicians also said prior authorizations can at least sometimes lead to treatment abandonment.

Even more troubling, 30 percent of physicians surveyed stated that prior authorization has led to a serious adverse event for a patient in their care.

Of these physicians, 21 percent said prior authorization has resulted in a hospitalization, while 18 percent of the respondents said the requirement led to a life-threatening event or required intervention to prevent permanent impairment or damage.

Nine percent said prior authorization led to patient disability, permanent bodily damage, congenital anomaly or birth defect, or death.

“Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency,” said Bailey. “This hard-learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification.”

AMA has been leading an effort to reduce prior authorization burden for physicians through a coalition of industry stakeholders that developed a roadmap for improving the administrative process. The coalition of pharmacists, medical groups, hospitals, and health plans signed a consensus statement in 2018 committing to improving prior authorizations.

But AMA reported in the latest press release that “health plans have made little progress in the last three years toward implementing improvements in each of the five areas outlined in the consensus statement.”

A survey conducted by America’s Health Insurance Plans (AHIP) last year, however, found that payers believe prior authorizations have a largely positive impact.  Most payers found prior authorizations to be an evidence-based system for ensuring quality of care, affordability, and safety.

More recently, AHIP also released survey results showing that electronic prior authorizations may improve quality of care while reducing the administrative burden of the process for providers.

Six in ten providers who used the prior authorization regularly said that electronic prior authorization made it easier to know whether they needed to request prior authorization.

Nearly the same number of providers who were well-experienced in prior authorizations (57 percent) also said that the electronic prior authorization requirements were easier to understand. Over half of them added that the prior authorization decision was easier to view.

Electronic prior authorization adoption is part of the process improvement steps outlined in the consensus statement signed by major payers.