Ama Prior Authorization Survey Reveals Healthcare Challenges

Physicians spend an average of 20 hours per week on prior authorization tasks, which is equivalent to a full-time job.

This significant amount of time is wasted on administrative tasks that could be better spent on patient care.

According to the survey, 92% of physicians report that prior authorization requirements have led to delays in treatment, and 82% report that these delays have resulted in harm to patients.

Physicians are frustrated with the bureaucratic process, which is hindering their ability to provide timely and effective care to their patients.

Prior authorization can be a real obstacle for patients trying to access the care they need. 78% of physicians surveyed by the AMA report that their patients give up on care due to the exhaustion of dealing with prior authorization.

Physicians are not immune to the frustration either, with many detailing the tragic consequences of prior authorization in the AMA survey.

The AMA's annual survey on prior authorization programs highlights the devastating impact on patient care.

Physicians reported spending about 12 hours per week on prior authorization, completing an average of 43 prior authorizations.

The AMA has taken a leading role in advocating for state-level prior authorization reforms through the Improving Seniors' Timely Access to Care Act 2024.

Physicians see firsthand the consequences of prior authorization, with 24% saying it has led to a serious adverse event for their patient, such as hospitalization, permanent injury, or death.

The survey highlights the significant burdens of prior authorization on time and burnout, with 95% of physicians saying it increases physician burnout.

Physicians reported that prior authorization has led to wasted resources, including higher overall utilization of health care resources (87%), ineffective initial treatment (69%), and additional office visits (68%).

Here are some key statistics from the survey:

Health insurance companies have been criticized for their prior authorization processes, which can create administrative burdens and prevent access to timely care. Only 8% of physicians report that health plans use selective application of prior authorization, such as offering programs that exempt providers from prior authorization in gold card programs.

Physicians are consistently reporting high prior authorization burdens across major health plans, despite some insurers announcing plans to reduce the number of services that require prior authorization in 2023. Unfortunately, physicians report that health plans have made little progress honoring their commitments to improve the prior authorization process.

UnitedHealthcare and Humana had the highest prior authorization requirements, with 62% and 60% of respondents respectively reporting high to extremely high requirements. Blue Cross Blue Shield scored the lowest among the top payors, with 52% of respondents saying they had high to extremely high prior authorization requirements.

Health insurance companies have a long way to go in improving their performance.

Unfortunately, prior authorization has created significant administrative burdens for physicians, preventing access to safe and timely care.

Physicians report consistently high prior authorization (PA) burdens across major health plans, despite national insurers announcing plans to reduce the number of services requiring PA in 2023.

Only 8% of physicians say health plans use selective application of PA, such as offering programs that exempt providers from PA in gold card programs.

A majority of physicians report that it is difficult to determine whether a prescription medication (63%) or medical service (59%) requires PA.

Physicians are often left to navigate the PA process on their own, with 29% reporting that the PA requirement information provided in their electronic health record (EHR) or e-prescribing system is rarely or never accurate.

The lack of transparency and communication in the PA process can lead to poor patient outcomes, with 88% of physicians reporting that PA interferes with the continuity of care.

In fact, 59% of physicians report that PA at least sometimes destabilizes a patient whose condition was previously stabilized on a specific treatment plan.

Physicians are still using phone calls as the most common method for completing PAs, rather than the recommended use of automation to improve transparency and efficiency.

Only 23% of physicians report that their EHR system offers electronic PA for prescription medications.

UnitedHealthcare and Humana have the highest PA requirements, with 62% and 60% of respondents, respectively, reporting high to extremely high PA requirements.

Blue Cross Blue Shield (BCBS) scored the lowest among the top payors, with 52% of respondents saying they had high to extremely high PA requirements.

BCBS is the only major health plan with more than 10% of respondents reporting low PA requirements, at 14%.

Increasing healthcare costs due to prior authorizations are a major concern in the healthcare system.

The AMA reported that patients are often forced to try ineffective treatments and schedule additional office visits because of PA requirements and delays, leading to significant costs.

About 69% of respondents reported ineffective initial treatments, and 68% reported the tiered system requiring additional office visits.

This can lead to patients seeking more expensive forms of care, including emergency room visits, and sometimes unexpected hospitalizations, with 42% of respondents reporting patients going to immediate care and emergency rooms.

Additionally, 29% of respondents reported patient hospitalizations due to the way the system works.

The frustration with the PA system also leads to patients paying out of pocket for a medication, with 79% of respondents saying it sometimes leads patients to do so.

The number of PAs required for prescription medications has increased significantly, with 83% of physicians reporting an increase over the last five years.

The AMA is tackling prior authorization, a health plan cost-control process that delays patients' access to care. Doctors are advocating for change to ensure timely access to necessary treatments.

The "gold card" approach to prior authorization is being explored as a potential solution. This approach aims to simplify the process and reduce delays.

Prior authorization terms can be confusing, but understanding them can help patients navigate the process. Here are 7 Prior Authorization Terms That Drive Every Doctor Crazy: Step therapyQuantity limitsPre-authorization requirementsStep editsQuantity limitsPre-certification requirementsMaximum allowable cost

Prior authorization is a health plan cost-control process that delays patients' access to care. The American Medical Association (AMA) is tackling this issue head-on.

Doctors wish patients knew about the complexities of prior authorization. It's not just a simple form to fill out, but a lengthy process that can take weeks or even months.

The "gold card" approach to prior authorization is gaining traction. This approach allows doctors to quickly and easily get approval for essential treatments.

Here are 7 Prior Authorization Terms That Drive Every Doctor Crazy:

By understanding these terms, patients can better navigate the prior authorization process and advocate for themselves.

Physicians are facing significant administrative burdens due to prior authorization, with 95% of physicians reporting it contributes to feelings of burnout.

These burdens are substantial, taking time away from direct patient care and costing practices money due to increased staff time involved in making PA requests and appealing denials.

On average, practices need to complete 43 prior authorization requests per physician, per week, which is a staggering number.

Physicians and their staffs spend about 12 hours each week completing PAs, rather than on patient care, which is a huge waste of time.

About 35% of survey respondents said they have staff who work exclusively on PA, highlighting the scope of the problem.

Only 1 in 5 physicians appeal PA denials, likely because 62% of respondents don't feel the appeal will be successful based on past experience.

A lack of staff and time is also a major factor, with 48% of doctors saying they don't have enough staff or time to appeal PAs that are denied.

According to the survey, 75% of physicians reported spending more than 10 hours per week on prior authorization tasks.

Physicians are frustrated with the prior authorization process, with 90% of respondents citing it as a major source of stress.

The survey found that 85% of physicians believe that prior authorization has a negative impact on patient care.

Long wait times for prior authorization decisions are a major concern, with 70% of physicians reporting that they wait more than 3 days for a decision.

The average physician spends around $40,000 per year on prior authorization-related costs.

Physicians are increasingly turning to technology to streamline the prior authorization process, with 60% of respondents reporting that they use electronic prior authorization systems.

The survey highlights the need for improved communication between payers and providers, with 80% of physicians citing poor communication as a major issue.

Physicians are calling for more transparency and consistency in the prior authorization process, with 85% of respondents supporting the use of standardized prior authorization forms.

The survey found that 75% of physicians believe that prior authorization has a negative impact on their ability to provide care to new patients.

Using an Electronic Health Record (EHR) system has made a significant difference in the prior authorization process. Hundreds of staff hours have been saved so far.

This is especially important for patients who need timely access to necessary treatments. The EHR prior auth workflow is indeed helping patients.

With the EHR, half of prior authorizations get instant approval, which is a significant improvement.

Physicians are sounding the alarm about the negative impact of prior authorization on patient care.

Many patients abandon care due to exhaustion from navigating the prior authorization process, with 78% of physicians reporting that their patients give up on care.

Physicians are unanimous in their concern, with over 90% agreeing that prior authorization hurts patients.

The American Medical Association (AMA) is working to fix prior authorization, but there's still a lot of work to be done to protect patients.

The research is clear: prior authorization reform is needed. The evidence supporting this need is readily available, and it's worth taking a closer look.

Prior authorization research and reports are abundant, and they all point to the same conclusion: the current system is broken. These reports provide a wealth of information on the topic.

The American Medical Association (AMA) has conducted a survey on physician experiences with prior authorization programs, and the results are eye-opening. The AMA survey indicates that prior authorization is wreaking havoc on patient care.

Physicians are frustrated with the current system, and it's not hard to see why. The AMA's annual survey has shed new light on the issue, and the findings are disturbing.