AAMC Urges Electronic Prior Authorization Reform

The organization wants to improve on administrative process delays often caused by payers.

The Association of American Medical Colleges (AAMC) has joined other groups in supporting electronic prior authorization reform with the aim of alleviating the burden on patients and providers.

In a letter to the Office of the National Coordinator for Health Information Technology (ONC), the AAMC expressed its concern with medical care delays caused by prior authorization and stated its belief that electronic health record (EHR) systems could be better used with automation to streamline the administrative process.

The ONC released a request for information in January to seek comment on electronic prior authorization standards, implementation specifications, and certification criteria to help potential future rulemaking.

The AAMC's comments follow those of the American Hospital Association, which advocated for a judicious approach to regulating prior authorization reform.

Similarly, the AAMC encourages solutions that have been fully developed and tested prior to industry rollout, stating "ONC and CMS should approach potential changes to regulatory schemes judiciously to effectively update and create standard transactions without unduly burdening health care payment processes."

As it relates, prior authorization can have the unintended consequence of negatively affecting patient outcomes. The AAMC points to a recent physician survey conducted by the American Medical Association (AMA) in which 80% of respondents said that patients abandon treatment due to authorization struggles with their health insurer.

"The AAMC recommends that any regulation standardizing prior authorization processing include requirements that health plans issue prior authorization determinations in a timely manner to ensure that patients benefit from process improvements," the group said.

The same AMA survey also found that 88% of responding physicians describe the burden of completing prior authorization as high or extremely high. Streamlining the process has the potential to significantly reduce provider burnout, according to the AAMC.

While the AAMC is mindful of the resources required to implement changes, it believes reform would be beneficial in the long run if insurers did their part and followed suit.

"Provider up-front investment to adopt and implement electronic prior authorization standards is worthwhile to improve care delivery so long as payers and health plans broadly adopt policies to support the use of electronic prior authorization to improve processing and approving requests," the AAMC concluded.