By Stacey Kusterbeck, Contributing Editor, Relias-AHC Media
Prior authorizations are more than just an administrative burden — they’re harming patients’ clinical outcomes by delaying necessary care, according to 92% of physicians surveyed by the American Medical Association (AMA).
The survey’s findings “really did confirm what each of us on the front lines taking care of patients is experiencing,” said Jack Resneck Jr., MD, chair-elect of the AMA.
About one-third of the 1,000 surveyed physicians reported waiting three business days or longer for prior authorization decisions; 78% reported that the authorization process “sometimes, often, or always” led to patients abandoning a recommended course of treatment.
“When we do hear back, it’s often just the first go around, with an automatic rejection, and we have to do a second level of appeal. While we are back-and-forthing with the health plan, the patient is waiting,” Resneck said. Insurers sometimes offer approved alternatives that are not appropriate for the patient’s condition.
A January 2018 consensus statement outlines a shared commitment to improvements to prior authorization processes. In March 2018, the AMA and Anthem announced a collaboration to streamline or eliminate low-value prior authorization requirements and implement policies to minimize care delays.
In the upcoming May issue of Hospital Access Management, Resneck outlines other areas of focus with prior authorization reform that are underway. These include making requirements more transparent for providers and lower authorization hurdles for physicians with a proven track record of high approval rates. For more on how prior authorization requirements are affecting the revenue cycle in the hospital setting, see the October 2017 issue of Hospital Access Management.