Practices Complete More Prior Authorizations, See More Care Delays

Practices are completing more prior authorizations compared to last year and seeing more care delays as a result, according to new data from the American Medical Association (AMA).

The AMA recently released its annual prior authorization physician survey, which polls over 1,000 practicing physicians about their experience with the prior authorization process. This year’s survey found that the burden of prior authorizations remains high, with 88 percent of responding physicians describing the process’ burden as high or extremely high.

About the same percentage of physicians in last year’s survey said the same despite AMA’s advocacy work over the last year aimed at reducing the administrative burden surrounding prior authorizations. The trade association says prior authorizations are “overused and existing processes present significant administrative and clinical concerns.”

The latest prior authorization physician survey data shows that, on average, practices complete 45 prior authorizations per physician per week, dedicating almost two business days each week to prior authorizations. Thirty-five percent of physicians also said they have staff who work exclusively on prior authorizations.

Completing prior authorizations may be getting in the way of quality care delivery, the survey also indicates. About 94 percent of physicians told the AMA that the prior authorization process delays access to necessary care, whether it is always, often, or sometimes. That percentage is up slightly from 93 percent of physicians in last year’s survey.

Approximately 80 percent of physicians also said prior authorizations at least sometimes result in treatment abandonment.

Payers use prior authorizations as part of utilization management programs aimed at reducing costs and unnecessary services. However, physicians do not believe prior authorizations are achieving their intended goals.

The survey shows that the majority of physicians — 86 percent — feel the prior authorization sometimes, often, or always leads to higher overall utilization of healthcare resources. For example, 64 percent of physicians reported ineffective initial treatments due to step therapy and 62 percent reported additional office visits because of the prior authorization process. Nearly half of physicians also said prior authorizations led to immediate care and/or emergency department visits.

The AMA and other trade associations have come down hard on prior authorizations. Just last month, the AMA and 118 other trade associations urged CMS to finalize reforms to the prior authorization process in Medicare Advantage, including continuity of care requirements. The associations also backed gold-carding programs, which allow physicians with high prior authorization approval rates to bypass requirements for a certain period of time.

CMS also released a proposed rule in December 2022, which would place new requirements on many Medicare Advantage, CHIP, Medicaid, and Qualified Health Plan payers, including electronic prior authorizations and shorter timeframes for responses.

AMA said the latest survey results underscore the need to streamline or eliminate prior authorization requirements leading to waste, delays, and disruptions in care delivery.

“Health plans continue to inappropriately impose bureaucratic prior authorization policies that conflict with evidence-based clinical practices, waste vital resources, jeopardize quality care, and harm patients,”  Jack Resneck Jr, MD, AMA president, said in an emailed statement. “The byzantine system of authorization controls is rife with opportunities for reform and the AMA continues to work with federal and state officials on legislative solutions to reduce waste, improve efficiency, and protect patients from obstacles to medically necessary care.