GAO recommends CMS continue prior authorizations, much to the ire of physicians

A doctor sitting at his desk working on a laptop computer.
A government watchdog recommends that the CMS continue its prior authorization pilots, which is likely to anger physicians. (Getty/monkeybusinessimages)

A government watchdog says the use of prior authorization keeps costs down, but that's unlikely to satisfy critics who say it hurts access to care.

The Government Accountability Office (GAO), in a report released May 21, said the Centers for Medicare & Medicaid Services (CMS) should continue its prior authorization demonstration projects, which have saved up to $1.9 billion through May 2017.

The agency launched seven state pilots in 2012 for some mobility devices, like wheelchairs, which are set to expire this summer.


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"CMS risks missed opportunities for achieving its stated goals of reducing costs and realizing program savings by reducing unnecessary utilization and improper payments," the watchdog said. 

In its response, the Trump administration said it would consider the recommendations as well as look at other cost-saving opportunities. 

RELATED: 5 ways physicians, payers will work together to streamline prior authorizations

However, physicians are unlikely to be happy with the recommendation. 

A recent survey (PDF) by the American Medical Association found that 92% of clinicians say such approvals impede and slow timely patient access to care and hurt outcomes. In addition, 64% of physicians said they wait, on average, at least one business day to hear back on a decision, with 30% waiting at least three business days.

Respondents also said about 14.6 hours are spent each week on an average of 29 prior authorization prescriptions and services. About one-third of physicians have staff that work exclusively on such approvals. 

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