Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization
More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey released today by the
"Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment," said AMA Chair-elect
According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers--and nearly a third (30 percent) said they wait three business days or longer.
The high wait times for preauthorized medical care have consequences for patients. More than nine in 10 physicians (92 percent) said that the prior authorization process delays patient access to necessary care; and nearly four in five physicians (78 percent) report that prior authorization can sometimes, often or always lead to patients abandoning a recommended course of treatment.
In addition, a significant majority of physicians (84 percent) said the burdens associated with prior authorization were high or extremely high, and a vast majority of physicians (86 percent) believe burdens associated with prior authorization have increased during the past five years.
The survey findings show that every week a medical practice completes an average of 29.1 prior authorization requirements per physician, which takes an average of 14.6 hours to process--the equivalent of nearly two business days. To keep up with the administrative burden, about a third of physicians (34 percent) rely on staff members who work exclusively on the data entry and other manual tasks associated with prior authorization.
"The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care," said
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Earlier this month, the AMA and
To further support prior authorization reform, the AMA has recently produced and released the following educational videos.
Video #1 highlights the new AMA survey and illustrates that the undue burdens of preauthorizing medical care and drug treatments have reached a critical level.
Video #2 highlights the real opportunity to improve patient experiences while significantly reducing administrative burdens for both payers and physicians by reforming prior authorization and utilization management programs with electronic prior authorization (ePA) that integrates within the electronic health record workflow.
Video #3 highlights how physicians can start using ePA and what the AMA is doing to help.
The AMA welcomes the opportunity to work collaboratively with health plans and others to create a partnership that lays the foundation for a more efficient prior authorization process. Please visit the AMA website to learn more about the organization's ongoing collaborative efforts.
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