Managed care has a lot of techniques that make life hard for doctors and patients, in the name of restricting unneeded care and reducing costs. The current least popular is prior authorization, which increasingly is used for any expensive drug and any other costly therapy. The American Medical Association released results of a survey of physicians regarding prior authorization. (AMA Survey) I would say consider the source when looking at the results, but I suspect they are pretty accurate. The survey covered 1000 doctors, 40% were primary care and 60% specialists. The average doctor said they had about 14 drug prior auths a week and 15 medical ones. those took 14.6 hours of staff time a week to handle and 34% of physicians said their practice had a full-time resource dedicated to prior authorizations. The average wait time for a prior authorization was described as less than an hour by 6% of respondents, a few hours by 10%, one business day by 16%, 2 business days by 18% and 3-5 business days by 23%. This resulted in care delays always according to 15% of doctors, often by 39%, sometimes by 38% and rarely by 6%. Patients abandoned treatment as a result of the prior auth process often, said 19% of physicians, sometimes said 57% and rarely said 19%.
The impact on clinical outcomes was significantly negative according to 61% of doctors, somewhat negative said 31% and 7% said it had no impact. The administrative burden was viewed as high by 84% of physicians while 12% said it was neither high nor low. 51% of respondents said that burden has increased significantly in the last couple of years and 35% said it had gone up somewhat. Prior authorization is a pain, but it has advantages. The patient and provider know before delivering a treatment that it will or won’t be paid for. A lot of prior authorizations are still done via fax and other time-consuming methods. There are groups working on fully automating the process, which should reduce the administrative burden and time involved. But that assumes payers want that to happen, right now those burdens cause a significant abandonment rate which saves them money. Now one way to avoid prior authorization is to put doctors at financial risk for the costs of providing care. That gets the health plans off the hook. I suspect physicians with financial risk will be a lot fonder of prior authorization and will be using it as much as health plans do. Wonder what the AMA thinks about that.