Prior Authorization Burden Continues to Rise, Physicians Report

Physicians are still expending a significant amount of time and resources on prior authorizations as the burden of the process continues to increase, according to a recent survey conducted by the American Medical Association (AMA).

The annual survey of 1,000 practicing physicians found that a vast majority of respondents (86 percent) described the administrative burden associated with prior authorizations as high or extremely high in 2019.

About 86 percent also felt that the prior authorization burden increased over the last five years. Of those respondents, half said the burden has increased significantly and the other half said it increased somewhat.

The most recent findings show no progress with reducing the prior authorization burden, which takes an average of almost two business days (14.4 hours) each week to complete according to survey respondents. Almost a third (30 percent) of physicians also have staff who work exclusively on prior authorizations, which averaged 33 a week in 2019.

Last year’s survey found that 86 percent of physicians found prior authorization burdens to be high or extremely high in 2018, and 88 percent said the burden had gone up in the last five years. In 2018, physicians also processed an average of 31 prior authorizations a week, with this workload consuming nearly 15 hours a week. Additionally, 36 percent of physicians reported having staff who work exclusively on prior authorizations.

“These new survey results highlight that practices continue to devote significant time—an average of nearly two business day per week per physician—navigating prior authorization’s administrative obstacles. Even more concerning, this process can harm our patients,” said Susan R. Bailey, MD, the AMA’s new president who was inaugurated in early June.

In the latest survey, 24 percent of physicians reported that prior authorization has led to a serious adverse event for a patient. Sixteen percent also said that prior authorization had led to a hospitalization.

Care delays were a serious concern for physicians, who overwhelmingly told AMA that prior authorizations often delayed access to necessary care for patients whose treatment required prior authorization.

Most physicians (64 percent) said they waited at least one business day for a prior authorization response from health plans, while 29 percent waited at least three business days, the survey found.

Nearly three-quarters (74 percent) of physicians also reported that prior authorizations can at least sometimes lead to treatment abandonment.

New survey results are troubling to the AMA, which has signed on to alleviate the prior authorization burden and ensure the process does not negatively impact patient care.

“Almost two and a half years after our consensus statement, the sad fact is little progress has been made toward the reform goals. The health insurance industry’s failure to achieve agreed-upon improvements illustrates a clear need for legislation like The Improving Seniors’ Timely Access to Care Act, H.R. 3107, to rein in prior authorization practices that adversely affect patient health,” Bailey said.

The consensus statement signed by AMA and others, including the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA), and Medical Group Management Association (MGMA), outlined five areas for prior authorization improvement:

• Selective application of requirements
• Adjustment of volume of requirements
• Improved transparency
• Protection for continuity of patient care
• Automation through standardized processes

AMA’s survey indicated that payers are failing to improve upon key areas, including volume requirements and protection for continuity of care. The Council for Affordable Quality Healthcare, Inc. (CAQH) also reported earlier this year that automation of prior authorizations remains low, which has led to increased costs for both providers.

On the part of payers, “subsequent inaction has translated into stalled progress and ongoing burdens for patients and physicians,” the AMA stated. But The Improving Seniors’ Timely Access to Care Act would help to accelerate progress in the five areas, the association said.

Introduced by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), the bill would require Medicare Advantage plans to streamline and standardize prior authorization processes and improve transparency of payer programs.

“Prior authorization is a common management tool, but the current landscape doesn’t provide the best utilization of it, resulting in physician burdens and patient access issues,” said stated Representative Marshall, who received his Medical Doctorate from the University of Kansas and practiced as an OB-GYN for 25 years. “Our bill will bring Medicare Advantage to the 21^st century by streamlining and modernizing the prior authorization process.”

The bill was introduced by the bipartisan group a year ago, but since then, it has gained steam. AMA pointed out that a bipartisan majority of more than 219 House Representatives have already co-sponsored the bill. The association has also created a campaign to garner support for the bill.