5 ways to streamline prior authorization, improve outcomes 

A stethoscope on a computer keyboard
Prior authorizations bloat physicians' already substantial administrative burden, according to a new survey. (Getty/anyaberkut)

Physicians say they face long wait times for insurers to process prior authorizations and the delays can negatively impact patient outcomes. 

The American Medical Association surveyed (PDF) 1,000 physicians, and 64% said they wait at least one business day for insurers to decide on prior authorization. Nearly one-third (30%) said they wait at least three business days for decisions. 

The vast majority of physicians surveyed said that lag time can have serious consequences for patients; 92% said the prior authorization process can lead to delays in access to care, and 78% said that waiting for a decision from insurers "sometimes, often or always" causes patients to abandon certain treatments entirely. 

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In addition, the prior authorization process can add to physicians' administrative burdens, according to the survey. On average, a practice completes 29.1 requests each week; 34% of the surveyed doctors said they have staff members who work solely on the data entry and other steps for prior authorization. 

"The AMA survey illustrates a critical need to help patients have access to safe, timely and affordable care, while reducing administrative burdens that take away from patient care," said Jack Resneck, Jr., the AMA's chair-elect, in an announcement

RELATED: Insurance, negative press coverage erode patient trust in the profession, physician says 

Physicians find the prior authorization process frustrating, and a number of physician groups have offered strategies that could streamline the process and ease the burden. The American Academy of Family Physicians said lightening the administrative load is its "most pressing priority," and has called for the reduction of prior authorizations. 

Six major industry groups—including America's Health Insurance Plans and the AMA—joined forces to improve the prior authorization process. The groups agreed to five steps: 

  1. Reduce the number of prior authorizations required based on physicians' performance
  2. Review procedures and drugs that require authorization and regularly evaluate which require those requests
  3. Increase communication to cut down on wait time
  4. Protect the continuity of care for patients with ongoing treatments so they don't face care gaps when coverage or prior authorization requirements change
  5. Speed up the adoption of electronic standards for prior authorization.

RELATED: Report sees potential for evolution of prior authorization models, payer-provider collaboration 

Earlier this month, the AMA announced that it would partner with Anthem to further a number of its goals, including finding ways to improve the prior authorization process. 

In the announcement of the survey results, the group said it welcomes the opportunity to collaborate with other payers on these issues. 

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