The latest survey from American Medical Association (AMA) indicates the consequences of excessive prior authorization controls.
Prior authorization, which insurers use to manage health care utilization and help control costs, can wreak havoc on patient care, according to the AMA survey of 1,000 practicing physicians. The 40-question, web-based survey was administered in December 2023 and included responses from both primary care physicians (40 percent) and specialists (60 percent).
Physicians reported in the survey that prior authorization barriers lead to serious or life-threatening events for patients, unnecessary waste, and physician burnout.
“Across the country, physicians see firsthand the dangerous, harmful—and sometimes deadly—consequences of prior authorization,” wrote AMA President Bruce A. Scott, M.D. in a viewpoint that accompanied the survey. “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 result can actually be increased 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.”
Patient harm
• Nearly one in four physicians (24 percent) reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
• More than nine in 10 physicians (93 percent) reported that prior authorization has a negative impact on patient clinical outcomes.
• More than nine in 10 physicians (94 percent) reported that prior authorization delays access to necessary care.
• Seventy-eight percent reported that their patients abandon treatment due to authorization struggles with health insurers
. • More than half of physicians (53 percent) who cared for patients in the workforce reported that prior authorizations had impeded a patient’s job performance.
Administrative burdens
• Physicians reported completing an average of 43 prior authorizations per week, and more than a quarter (27 percent) of physicians reported that prior authorization requests are often or always denied.
• Prior authorization requirements for a single physician consume the equivalent of 12 hours of physician and staff time each week, and more than a third (35 percent) of physicians employ staff members to work exclusively on tasks associated with prior authorization.
• More than nine in 10 physicians (95 percent) reported that prior authorization somewhat or significantly increases physician burnout.
Wasted health resources
• More than four in five physicians (87 percent) reported that prior authorization requirements lead to higher overall utilization of health care resources, resulting in unnecessary waste rather than cost-savings.
• Physicians reported resources were diverted to ineffective initial treatments (69 percent), additional office visits (68 percent), urgent or emergency care (42 percent), and hospitalizations (29 percent) due to prior authorization requirements.
The findings underscore the need for comprehensive prior authorization reforms, the AMA said in the survey announcement. In addition to advocating for state-level reforms, the association strongly supports bipartisan and bicameral federal legislation to reform prior authorization procedures within Medicare Advantage.
“The time is now for Congress to adopt reintroduced prior authorization reform legislation that prioritizes patients’ access to care, reduces administrative burdens on physicians, and preserves resources for high-quality care,” said Dr. Scott. “Because insurers will not change their ways despite their rhetoric, lawmakers have an important opportunity to rein in excessive prior authorization requirements and unnecessary administrative obstacles between Medicare Advantage patients and evidence-based treatments.”