Prior Authorization Hurts Patient Care, AMA Survey Finds

Requiring physicians to ask for preauthorization from health insurance companies harms patient care, and creates an expensive and confusing claims process, according to a national survey released by the American Medical Association.

"Intrusive managed care oversight programs that substitute corporate policy for physicians' clinical judgment can delay patient access to medically necessary care," said AMA Immediate Past President J. James Rohack, MD. "According to the AMA survey, 78% of physicians believe insurers use preauthorization requirements for an unreasonable list of tests, procedures and drugs."

The AMA said the national survey—released this week— of approximately 2,400 physicians is an attempt to quantify the burden of preauthorization mandates for a growing list of routine tests, procedures and drugs. Physicians complained that preauthorization delays or interrupts patient care, wastes time, and complicates medical decisions.

The survey found that:

• 37% of physicians experience a 20% rejection rate from insurers on first-time preauthorization requests for tests and procedures, and 57% experience a 20% rejection rate on first-time preauthorization requests for drugs.
   
• 46% of physicians had difficulty getting approval from insurers on 25% or more of preauthorization requests for tests and procedures, and 58% experience difficulty getting approval from insurers on 25% or more of preauthorization requests for drugs.
   
• 63% of physicians typically wait several days to receive preauthorization from an insurer for tests and procedures, while 13% wait more than a week. And 69% of physicians typically wait several days to receive preauthorization from an insurer for drugs, while 10% wait more than one week.
   
• 64% of physicians have trouble determining which test and procedures require preauthorization, and 67% have trouble determining which drugs require preauthorization.

A Health Affairs study published in 2009 showed that navigating the managed care maze costs physicians $23.2 to $31 billion a year.

AMA said its survey showed that preauthorization policies create costly bureaucratic hassles that take time away from patients. Physicians in the survey said they average 20 hours each week dealing with preauthorizations.

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