Doctors Still Love Prior Authorization

By February 8, 2019 Commentary

The American Medical Association releases yet another study describing the fondness physicians hold in their hearts for prior authorization processes.   (AMA Study)   Now this was a self-selected group of respondents to a web-based survey from a 1000 member sample, so they might feel particularly strongly about the subject, but I suspect their views are actually fairly representative.  65% of the physicians said that over the last week, they waited an average of at least one business day to get a response to a prior authorization request.  26% said they waited at least three business days.  Only 17% said it was less than a few hours.  Only 7% of doctors said the prior authorization process rarely resulted in care delays.  28% claimed that the process led to a serious adverse event.  75% of respondents said the process led to abandonment of treatment often or sometimes.  91% expressed the opinion that prior authorization had a negative impact on clinical outcomes.  86% said the process imposes a high or extremely high burden on their practice and 50% responded that the burden has increased significantly over the last five years and another 38% said it increased somewhat.  On average, practices said they had 31 prior authorizations per physician per week and they reported that the practice spent about 15 hours a week dealing with the process.  A third of doctors said they have staff who works only on prior authorization.

Now I don’t think prior authorization is the best way to deal with issues of ensuring appropriate care.  But the spread of expensive therapies has to some extent forced plans to try to proactively limit their use.  And the plans probably don’t care if these therapies are abandoned.  When providers are at risk, as they increasingly are, health plans should be able to avoid use of PA, since the physicians then have an incentive to be careful to ensure appropriate use of treatments and diagnostics.  But prior authorization is also to some extent a result of doctors not sticking to evidence-based care or just not taking the time to ensure that a treatment is appropriate for a specific patient.  And sometimes that happens because the physician has a financial incentive to deliver the care.  So I have less sympathy than I otherwise might.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

More posts by Kevin Roche

Leave a Reply