AMA Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization

The results of a recently released American Medical Association (AMA) survey found that 92 percent of physicians say that prior authorization programs have a negative impact on patient clinical outcomes. The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed.

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 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.

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.

In January 2017, the AMA with 16 other associations urged an industry-wide reassessment of prior authorization programs to align with a newly created set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other health care organizations have supported those principles.

In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association in a Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

Earlier this month, the AMA and Anthem announced a collaboration that would include, among other goals, identifying opportunities to streamline or eliminate low-value prior-authorization requirements and implementing policies to minimize delays or disruptions in the continuity of care.

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.

Please visit the AMA website to learn more about the ongoing collaborative efforts.


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