Dive Brief:

A new American Medical Association survey found that 92% of physicians report prior authorizations have a negative impact on patient clinical outcomes.

The survey of 1,000 practicing physicians found that 64% reported needing to wait at least one business day for payer prior authorization decisions and 30% waited three business days or longer.

The AMA is working with Anthem and other major healthcare players on collaborative efforts to improve prior authorization processes.

Dive Insight:

Payers have used prior authorization for years to prevent unnecessary care, but the practice is unpopular and can be a headache for hospitals, patients and even payers. The Academy Academy of Family Physicians calls prior authorizations “the number one administrative burden” for family physicians.

The AMA said the survey results show that prior authorization programs need reforms. AMA Chair-elect Dr. Jack Resneck Jr. said prior authorization programs can help limit overprescribing and overuse of medical services. However, payers often require too much prior authorization. Resneck gave an example of payers requiring prior authorization for generic medications.

Those processes are “a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care.”

Over-demanding pre-authorization can have medical care consequences for patients. In addition to the vast majority of physicians who said prior authorization delays patient access to necessary care, 78% of physicians said prior authorization can result in patients “abandoning a recommended course of treatment.”

Prior authorization can also cause administrative headaches for physician practices, with 84% of physicians saying prior authorization burdens are either high or extremely high.

How much of a burden? The survey found medical practices average 29.1 prior authorization requests per week. Processing those requests takes an average of 14.6 hours per week. With those administrative tasks to tend to, 34% of physicians said they rely on staff to work solely on data entry and other manual tasks connected to prior authorization.

The problems may be getting worse, too. The survey said 86% found prior authorizations have increased over the past five years.

“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,” Resneck said. “In response, the AMA has taken a leading role in convening organizations representing, pharmacists, medical groups, hospitals and health insurers to take positive collaborative steps aimed at improving prior authorization processes for patients’ medical treatments.”

The AMA is working with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association on a project to improve prior authorization processes and lower administrative burdens.

The AMA is also working with Anthem on a project to streamline processes and eliminate low-value prior-authorization requirements. The project’s goals are to create policies to minimize delays and disruptions in care.

Prior authorization issues also recently got the attention of two states. California and Colorado are investigating Aetna’s prior authorization practices after a former medical director claimed he didn't review patient medical records when deciding on authorization. Instead, he followed guidance from Aetna nurses who reviewed the information, he said.