Among America’s physicians, more than nine in 10 surveyed say that prior authorization has a negative impact on patient clinical outcomes.
Most telling is that 78% of physicians reported that prior authorization often or sometimes results in their patients abandoning a recommended course of treatment, according to the results of the AMA’s annual nationwide prior authorization survey (PDF) of 1,000 practicing physicians.
In addition to patients forgoing care, physicians also see the burdensome insurance company practice known as prior authorization leading to care delays and serious adverse events.
Among the physicians surveyed, these shares said that prior authorization:
- Always, often or sometimes delays patients’ accessing necessary care—94%.
- Resulted in a serious adverse event leading to a patient being hospitalized—19%.
- Resulted in a serious adverse event leading to a life-threatening event or requiring intervention to prevent permanent impairment or damage—13%.
- Resulted in a serious adverse event leading to a patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—7%.
In addition, 53% of physicians with patients in the workforce said prior authorization affected their patients’ job performance.
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“Across the country, physicians see firsthand the dangerous, harmful—and sometimes deadly—consequences of prior authorization,” AMA President Bruce A. Scott, MD, wrote in a Leadership Viewpoints column accompanying the survey’s release.
“Payers erect roadblocks and hurdles allegedly designed to save money for the health system and protect precious resources, but when patients and their doctors face care delays—or even give up and abandon necessary care—the results can increase overall costs when worsening health conditions force patients to seek urgent or emergency treatment. Our patients are caught in the middle, twisting in the wind, while physicians fight for them, often with fax machines as our only available weapon.”
The AMA is fixing prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Beyond the patient toll
Prior authorization also places a huge burden on physicians. The process is taking away from the time they would spend with patients and requiring them to hire office staff to specifically handle the paperwork and appeals.
Physicians reported that:
- On average, their practices complete 43 prior authorizations per physician, per week.
- They and their staff spend 12 hours completing prior authorizations each week.
- Prior authorization somewhat or significantly increases physician burnout, with 95% of physicians feeling that way.
- Few peer-to-peer consultations are with a “peer” who often or always has the appropriate qualifications. Just 15% of physicians surveyed reported that they often or always speak to the appropriate peer.
And the survey revealed that prior authorization adds significant costs to the entire health care system. Among physicians surveyed:
- 87% said that prior authorization leads to higher overall health care utilization.
- 79% said prior authorization led to patients paying out of their own pocket for a medication.
- 69% reported ineffective initial treatments; for example, due to step-therapy requirements.
- 68% said prior authorization led to additional office visits.
- 42% reported immediate care or emergency department visits.
- 29% reported hospitalizations.
Fixing prior auth in Medicare Advantage
After some progress on the state and federal legislative fronts last year, Congress is poised to take action to make more improvements to prior authorization this year.
In June, bipartisan and bicameral congressional legislation was reintroduced that would streamline and standardize how Medicare Advantage uses prior authorization. The AMA supports the legislation, the Improving Seniors’ Timely Access to Care Act of 2024 (PDF). The bill is an updated version of legislation that didn’t pass the Senate in the last Congress.
“One thing I would love my legislators to understand is that this is a waste of physicians’ time, a waste of money, but more importantly a stress for the patients,” Dr. Scott said in an AMA video on prior authorization. “The patients and the physicians work together to develop a plan and they know what is best for them. The insurance company should not be inserting themselves into that relationship.”
At its Annual Meeting in June, the AMA adopted several policies aimed at improving patients and physicians’ prior authorization experiences. The AMA is calling for insurers to provide more information in denial letters, providing more real-time information about what medications don’t require prior authorization and calling for more legal accountability for insurers who cause patient harm by delaying or denying care.
Learn more about what needs to be done to fix prior authorization and learn more about the AMA’s reform efforts and share your personal experiences with prior authorization at FixPriorAuth.org.
