AMA: Nearly one in four physicians say prior authorization led to serious adverse events
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Key takeaways:
- Physicians reported that prior authorizations diverted time, increased health care utilization and delayed care.
- Overall, 27% said prior authorizations are often or always denied.
New survey results from the AMA illustrate the burden of prior authorization, with many physicians reporting that it leads to serious patient harms, delays care, reduces work productivity and more.
“Across the country, physicians see firsthand the dangerous, harmful — and sometimes deadly — consequences of prior authorization,” AMA President Bruce A. Scott, MD, said in a related viewpoint. “Payers erect roadblocks allegedly designed to save money for the health system and protect their resources, but when patients and their doctors face care delays — or when they give up and abandon necessary care — the result can increase overall costs when worsening health conditions force patients to seek urgent or emergency treatment.”
Ultimately, patients “are caught in the middle, twisting in the wind, while physicians fight for them, often with fax machines as our only available weapon,” Scott added.
One thousand practicing physicians — 600 of whom primary care physicians — participated in the annually conducted survey, which examined the impact of prior authorization on providers, patients, employers and health care utilization and outcomes.
Among responding physicians:
- 94% said prior authorization delays access to care;
- 24% said prior authorization has led to a serious adverse event for their patient, such as hospitalization (19%), permanent injury (13%) or death (7%);
- 78% said patients abandon treatment due to issues with health insurers regarding prior authorization;
- 53% said prior authorization has impeded a patient’s job performance; and
- 93% said prior authorization has a negative impact on patient clinical outcomes.
The survey results highlight the significant burdens of prior authorization on time and burnout, according to the AMA. For example, in a week, physicians reported spending about 12 hours on prior authorization, completing an average of 43 prior authorizations. However, 27% said prior authorization requests are often or always denied.
Additionally, 35% of physicians reported having staff who exclusively work on prior authorization, and 95% said prior authorization somewhat or significantly increases physician burnout.
Prior authorization was also tied to greater expenditures and wasted resources, with many physicians reporting that it has led to:
- higher overall utilization of health care resources (87%);
- ineffective initial treatment (69%);
- additional office visits (68%);
- immediate ER or care visits (42%); and
- hospitalizations (29%).
Physicians noted that health plans have made little progress on following the commitments outlined in the AMA’s 2018 consensus statement on improving prior authorization.
In a press release, the AMA said it has taken a “leading role” in advocating for state-level prior authorization reforms through the Improving Seniors’ Timely Access to Care Act 2024, of which these data support its need.
The legislation “would codify many elements of the CMS regulation, as well as empower the agency to take additional steps to prevent care delays and improve transparency,” Scott said. “Working together, we can protect patients and improve the health of our nation by removing the unnecessary and potentially devastating impediments posed by unduly onerous prior authorization policies.”
References:
- AMA survey indicates prior authorization wreaks havoc on patient care. https://www.ama-assn.org/press-center/press-releases/ama-survey-indicates-prior-authorization-wreaks-havoc-patient-care. Published June 18, 2024. Accessed June 18, 2024.
- Consensus statement on improving the prior Authorization process. https://www.mgma.com/getkaiasset/87f683d9-401c-4137-946b-761abe36c2f7/01.01.2018_PA-consensus-statement.pdf. Accessed June 18, 2024.
- We must fix prior authorization to protect our patients. https://www.ama-assn.org/about/leadership/we-must-fix-prior-authorization-protect-our-patients. Published June 18, 2024. Accessed June 18, 2024.
- 2023 AMA prior authorization physician survey. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf. Accessed June 18, 2024.
Perspective
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The AMA’s survey illustrates the frustration physicians experience during the prior authorization process. In the past, the prior authorization procedure was directed toward high-cost elective diagnostic testing and non-critical pharmaceuticals. This method was a nuisance, indeed; however, it did not potentially harm patients nor significantly delay or disrupt patient care. At some unobserved juncture in the past, a transition occurred where the system expanded to a cost control measure with a draconian tone and without any nuance for patient care. The resource expenditure for a clinical practice to participate in the burdensome process is massive in scale and may adversely influence patient care. The health care industry conveys no inclination to alter the system, which benefits their bottom line. I agree it is time for a legislative remedy to protect patients and the practice of medicine.
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