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AMA, AHIP Find Common Ground on Preauthorizations

Jeff Elliott, for HealthLeaders Media, December 15, 2010

"Nearly all physicians surveyed said that streamlining the preauthorization process is important, and 75 percent believe an automated process would increase efficiency," Rohack stated. "The AMA is urging health insurers to automate and streamline the current cumbersome preauthorization process so physicians can manage patient care more efficiently."

No argument here, say health plans. “We agree with physicians and AMA that it’s important to address the issue of efficiency,” according to trade association America’s Health Insurance Plans spokesperson Susan Pisano. “At the end of the day, we all want the same thing. We want patients to be treated in a safe and effective manner.”

According to Pisano, AHIP is sponsoring projects in which healthcare payers are collaborating with physicians to address how to improve efficiencies in the preauthorization process. Among them, five major health plans in New Jersey in collaboration with several provider organizations are investigating a single channel—in this case a Web portal—that provides physician access to multiple insurers to streamline administrative tasks such as checking claim status and preauthorizing services.

But let’s not take this as a sign that health plans and providers are in complete agreement. While declining to comment specifically on AMA’s survey, Pisano defended insurers’ preauthorization practices saying that its used much more selectively now days. “Generally these are things where there is a lot of variation between practices or there is documented concern about overuse and patient safety.”

So while physicians will continue to cringe at the notion that their judgment is being undermined while health plans stick to their guns on PPPP (profit-preserving preauthorization policies), let's enjoy this moment when both groups are working simultaneously to make at least the administrative function more efficient.

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1 comments on "AMA, AHIP Find Common Ground on Preauthorizations"


Arnold Herman MD FACS (12/16/2010 at 5:20 PM)
The biggest problem with prior authorizations is that even when we go through the process to obtain prior authorization, there is no certainty that the test/procedure will be paid for by the insurance company. The disclaimer that "prior autorization does not guarantee payment" should be eliminated, ot the prior autorization for that procedure removed.