MGMA19: No progress to fix prior authorization, as practice leaders say it's gotten worse

Young female doctor sitting at desk in front of computer covering face with hand in frustration
In a recent survey, 90% of practice leaders said payer prior authorization requirements have increased in 2019. (Getty Images/PRImageFactory)

NEW ORLEANS—Having to seek prior authorization from payers is the most burdensome regulatory issue, and it’s only getting worse, according to practice leaders..

In a survey released this week by the Medical Group Management Association (MGMA), 83% of respondents said prior authorizations are “very” or “extremely” burdensome.

But there’s been no progress in resolving the issue that has providers and payers at odds, Robert Tennant, director of health information technology policy for MGMA’s government affairs, told an audience Tuesday at the group’s annual conference in New Orleans.

Webinar

On The Front Lines: How Payers Can Combat The Opioid Epidemic

What will it take to solve the opioid epidemic? In this webinar, we’ll share real-world strategies and best practices for health insurance leaders on the front lines and explore what’s working and how to overcome common challenges.

“Things are actually getting worse, not better,” Tennant said.

Robert Tennant
Robert Tennant (MGMA)

In a separate MGMA Stat poll last month, 90% of practice leaders said payer prior authorization requirements have increased in 2019. Only 1% said those requirements have decreased, and 9% said they have stayed the same.

There are approximately 182 million prior authorization transactions per year in the medical commercial market alone as providers request approval from health plans for specific procedures, medications, services or medical devices, Tennant said.

Six leading health industry groups representing physicians and payers, including MGMA, signed a consensus statement last year in which they vowed to collaborate to help relieve the prior authorization problem.

RELATED: AMA survey: 28% of physicians say prior authorizations led to serious adverse events

“Then the plans did absolutely nothing,” Tennant said. “It is a tough fight.”

Payers are also opposed to a bipartisan bill introduced in the House that would reform the prior authorization process for Medicare Advantage plans, despite the fact it is crafted based on that consensus statement, he said.

“Health plans now are backtracking. They are pushing back as hard as they can,” he said.

A member of the audience suggested that instead of talking about the impact on health plans and providers, proponents should focus on the patient and what happens when they have to wait to have a medication or test approved. “We have to tell patients, ‘we’re trying to work with the insurance company and we’re waiting,’” she said.

“You’re 100% right,” Tennant said.

More people are paying attention to the issue, including Congress. The House Committee on Small Business hosted a hearing in September with physicians to discuss the impacts of prior authorization on smaller practices. 

Payer groups have stepped up to defend the practice, which they say is a crucial tool to prevent unneeded treatments and can control soaring healthcare costs. 

Prior authorization is a pain point for doctors across the health system, who argue it delays care and piles additional administrative burden on their workloads. A survey from the American Medical Association released earlier this year found that 28% of docs believe prior authorization causes adverse events for patients

Suggested Articles

Insurer and business groups are ramping up efforts to delay the ACA's insurer tax as a year-end deadline looms.

The VA put millions of people, including medical professionals, at risk of identity theft by not redacting personal information from claims records.

There are unique opportunities to leverage clinical data registries in physician recruitment.