Docs say Pandemic Provided Scant Relief from Prior Authorization Mandates

AMA survey finds 94% of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers.

Even as COVID-19 cases were spiking in late 2020, physicians complained that health insurance companies were continuing to demand prior authorization for patient care, a new survey shows.

According to the findings, commissioned by the American Medical Association, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 said payers had either gone back to past prior authorizations policies or never relaxed these policies in the first place.

Ninety-four percent of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers, the survey found.

AMA President Susan R. Bailey, MD, said some payers had relaxed prior authorization requirements at the onset of the pandemic in early 2020, but that that changed as the public health emergency wore on.

"By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care," Bailey said.

The survey also found that 30% of physicians reported that prior authorization requirements led to serious adverse events for patients in their care, including:

• Patient hospitalization – reported by 21% of physicians;
   
• Life-threatening event or intervention to prevent permanent impairment or damage – reported by 18% of physicians;
   
• Disability or permanent bodily damage, congenital anomaly, birth defect, or death – reported by 9% of physicians.

The survey also found that:

• Only 15% of physicians reported that prior authorization criteria were often or always based on evidence-based medicine.
   
• 90% reported that prior authorizations programs have a negative impact on patient clinical outcomes.
   

• 85% said the burdens associated with prior authorization were high or extremely high.
   
• Medical practices complete an average of 40 prior authorizations per physician, per week, which consume the equivalent of two business days (16 hours) of physician and staff time.
   
• 40% of physicians employ staff who work only on prior authorizations.

Bailey said the findings illustrate the need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery.

"Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency," she said. "This hard- learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification."