AMA Survey: Prior Authorizations Delay Access, Negatively Impact Clinical Outcomes

Prior authorizations (PAs) delay care, have a significant negative impact on clinical outcomes, and place a high burden on providers, according to a survey of physicians conducted by the American Medical Association (AMA).

In 2017, the survey investigated attitudes toward PAs among 1000 practicing US physicians (40% primary care physicians and 60% specialists) who provide 20 hours or more of patient care per week, and who complete PAs as part of a typical week in practice. The 27 questions assessed wait times, outcomes, and burden of completing PAs.

Most physicians (64%) reported waiting at least 1 business day after submitting a PA for a decision from a health plan, and 30% reported waiting at least 3 business days. Nearly all (92%) physicians said that PAs delay patients’ access to necessary care, with 38% of respondents reporting that PAs “sometimes” create delays, and 39% saying that they “often” delay care.

Treatment abandonment was also a concern; 78% of respondents said that PAs can, at least in some cases, lead to a patient abandoning a recommended course of treatment (with 57% saying that it was “sometimes” the case and 19% saying that it was “often” the case). Most physicians (61%) also saw PAs having a significant negative impact on clinical outcomes. An additional 31% said that they saw PAs as having a somewhat negative impact.

In terms of the burden imposed by completing PAs, 84% of respondents said that they faced a high or extremely high burden, and 51% said that the burden had increased significantly over the past 5 years. On average, physicians had to complete 29.1 total PAs (for prescriptions and medical services) in a given week. These PAs took an average of 14.6 hours, or approximately 2 business days, of staff time to address the workload, and 34% of practices devoted staff to working exclusively on these PAs. The majority (79%) of respondents said they sometimes, always, or often had to repeat PAs for prescription medications that treat patients who are stable on their treatment regimens for chronic conditions.

Prior authorizations have long been a concern of the AMA; according to the organization, utilization management programs—including PAs and programs such as step therapy—can create significant barriers for patient-centered care, as the manual, time-consuming processes often used in these programs place additional burdens on providers and direct resources away from patient care. The group put forward 21 principles (which focus on clinical validity of utilization management programs, the continuity of care, transparency and fairness, timely access and administrative efficiency, and alternative and exemptions), to improve prior authorization practices. The release of these principles led the AMA, the American Hospital Association, America’s Health Insurance Plans, the American Pharmacists Association, the BlueCross BlueShield Association, and the Medical Group Management Association to adopt a new consensus statement on improving the PA process that aligns with the principles developed by the AMA.

Legislative solutions, too, are on the AMA’s mind; the organization has penned sample state legislation, which it calls the “Ensuring Transparency in Prior Authorization Act,” that could limit the administrative burden of PAs on practices and streamline the PA process to help prevent delays in patient care.