AMA Survey Finds that Prior Authorization Harms Affected person Care – Coverage & Medication

A recent physician survey discovered that the prior authorization course of exceeds the advantage of the method to sufferers, based on a doctor survey carried out by the American Medical Affiliation. In accordance with the survey, whereas well being insurers say that prior authorization necessities are essential for price and high quality management, physicians say that prior authorization controls result in pointless waste and avoidable affected person hurt.

The survey discovered that 86% of physicians reported that prior authorization necessities led to larger total utilization of well being care assets. This consists of the 64% of physicians who reported assets being diverted to ineffective preliminary therapies, 62% of physicians who reported extra workplace visits due to prior authorization insurance policies, and 46% of physicians who reported prior authorization insurance policies led to both pressing care or emergency look after sufferers.

Moreover, one-third of physicians reported that prior authorization practices led to a severe hostile occasion for certainly one of their sufferers, together with hospitalization, everlasting impairment, and even dying. Moreover, 94% of physicians reported prior authorization practices delaying entry to essential care (with 42% saying it usually causes delay to essential care) and 80% of physicians reported that sufferers had deserted a course of therapy resulting from prior authorization struggles. The survey additionally discovered that 58% of physicians reported that prior authorizations impacted a affected person’s means to carry out their job, leading to misplaced workforce productiveness.

Whereas medical insurance trade believes that prior authorization standards displays evidence-based drugs, doctor experiences query that precept as solely 15% of physicians reported that prior authorization standards have been at all times or usually proof primarily based. 31% of physicians reported that prior authorization standards have been hardly ever or by no means evidence-based.

Not solely did the survey discover that prior authorizations had a adverse total affect on affected person well being, however 88% of physicians mentioned that burdens related to prior authorizations have been both excessive or extraordinarily excessive. The executive burden related to prior authorizations prices medical practices a mean of 14 hours of doctor and workers time every week. A couple of-third of physicians had members of their workers that have been solely engaged on duties related to prior authorizations.

“Well being plans proceed to inappropriately impose bureaucratic prior authorization insurance policies that battle with evidence-based medical practices, waste important assets, jeopardize high quality care, and hurt sufferers,” said AMA President Jack Resneck Jr., M.D. “The byzantine system of authorization controls is rife with alternatives for reform and the AMA continues to work with federal and state officers on legislative options to scale back waste, enhance effectivity, and shield sufferers from obstacles to medically essential care.”

AMA Additionally Submitted Feedback to CMS Concerning Prior Authorization Reform

The AMA used the findings from this report to spice up comments submitted to the Facilities for Medicare and Medicaid Providers (CMS) in assist of CMS’ proposals to improve prior authorization throughout federal and state insurance coverage packages. The AMA’s feedback referenced the AMA Recovery Plan for America’s Physicianswith which one of many major 5 pillars is fixing prior authorization to scale back the burden on doctor practices and decrease harmful care delays for sufferers. Whereas the AMA helps the company’s efforts to reform prior authorization, the feedback additionally included suggestions to strengthen the proposals, together with feedback round payer transparency and processing time necessities.

MGMA additionally submitted comments in response to these proposed guidelines, additionally taking the chance to make solutions to the company on how prior authorization could possibly be reformed to assist sufferers. Among the solutions within the MGMA feedback included eliminating step remedy and shortening the timeframe that well being plans have to reply to medical teams for prior authorization requests.