Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:
- Clinical validity,
- Continuity of care,
- Transparency and fairness,
- Timely access and administrative efficiency, and
- Alternatives and exemptions.
The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to an AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.
The AMA survey illustrates that physician concerns with the undue burdens of preauthorizing medical care have reached a critical level. Highlights from the AMA survey include:
- Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.
- More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
- Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least 1 business day for prior authorization decisions—and more than 25 percent of physicians said they wait 3 business days or longer.
- Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.
The AMA, along with the NCMS and other coalition organizations are seeking to work collaboratively with health plans and others to create a partnership that lays the foundation for a more efficient prior authorization process.