Survey: Prior authorization impacts care significantly

According to the results of an American Medical Association survey, more than 90% of physicians surveyed stated prior authorization has a significant or somewhat negative clinical impact on patient care. Twenty-eight percent responded that prior authorization “led to a serious adverse event such as death, hospitalization, disability, or permanent bodily damage, or other life-threatening event for a patient in their care.”

For those who may not be familiar with the term, prior authorization requires physicians to be granted approval prior to delivering certain treatments or services to patients in order for the care to qualify for payment. This is a way for health plans to control costs, but it creates a high administrative burden for physicians and ultimately delays treatment. Historically, prior authorization applied to relatively new or costly treatments; now, however, physicians say prior authorizations are being increasingly required for services and treatments that are inexpensive and/or not new.

One thousand physicians participated in the survey. Sixty-five percent of respondents stated that it took at least one business day, on average, to hear back from health plans about prior authorization. Furthermore, 75% of respondents stated the need for prior authorization may cause patients to stop seeking treatment.

Source: American Medical Association