Doctors say prior authorization led to life-threatening delays in care


While providers expected insurers to relax prior authorization policies during the pandemic, 70% of surveyed physicians reported the changes were brief, if made at all, and did not relieve some of their burdens.

Slow prior authorization protocols contributed to care delivery delays and poor treatment outcomes for some patients during the surge in COVID-19 cases last winter, according to American Medical Association survey.

Nearly all physicians surveyed said they spent 16 hours on average seeking prior authorization for patient care, which delayed treatment. The physicians reported processing 40 prior authorizations per week, and approximately half of those surveyed say they had to hire additional staff to oversee the process.

More than 70% of physicians reported a patient abandoning treatment completely due to the added wait time and 90% say prior authorization had a negative impact on a patient’s treatment outcome.

One-third of physicians reportedly had a patient suffer a serious medical event as a result of delayed access to treatment. Almost 20% say a patient had a life-threatening event or had to be hospitalized. Fewer than 10% of physicians said a patient died or incurred a permanent disability as a result of prior authorization delays.

At the time of the survey COVID-19 cases peaked at 248,910 in a day, the highest daily caseload recorded to date.

Nearly all health plans claim that their prior approval processes for specific treatments are informed by evidence-based medicine or guidelines from national medical societies. A third of physicians did not believe prior authorization followed those guidelines.

“This hard-learned lesson must guide a re-examination of administrative burdens imposed by health insurers, often without any justification,” AMA President Dr. Susan R. Bailey said in response to the survey.

The AMA called for increased transparency in insurers’ criteria for prior authorization and for the streamlining of low-value prior authorization requirements in 2018 through a consensus statement with other major hospital organizations. The statement recommended improving access to care for patients through electronic transactions to expedite coordination and outreach through websites to make changes in policy accessible to a wider demographic of patients. Many patients are unaware that prior authorization can stall prescription medications and therapies for serious, chronic conditions.


Source: modernhealthcare.com

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