Prior Authorization Statistics: The Path to Better Patient Outcomes

Prior authorization statistics reveal a complex landscape, with a staggering 88% of healthcare providers reporting that prior authorizations delay patient care. This delay can have serious consequences, with 77% of providers stating that prior authorizations lead to adverse patient outcomes.

The average provider spends around 30 minutes per day on prior authorization tasks, which can be a significant burden considering the time could be spent on more patient-facing activities. This inefficiency is a major concern, especially given the fact that 71% of providers believe prior authorizations divert resources away from patient care.

The impact of prior authorization delays is not limited to patients; it also affects healthcare providers, with 64% reporting that prior authorizations lead to increased administrative burdens. This added workload can be overwhelming, particularly for smaller practices or those with limited staff.

Suggestion: United Health Prior Authorization

Prior authorization is not just a hassle for practices, but it also has a significant impact on patient care. Physicians spend an average of 14 hours a week, or almost two business days, completing prior authorization requests.

This administrative burden is staggering, with 35% of physicians having to hire additional staff to work exclusively on prior authorization requests. The high administrative burden is also a major reason why 89% of physicians say prior authorization has made a somewhat or significantly negative impact on patients' clinical outcomes.

Physicians complete an average of 45 prior authorization requests a week, which can lead to care delays. In fact, 94% of physicians say prior authorization leads to care delays at least some of the time, with 42% saying these delays happen often and 14% saying they always happen.

The impact of prior authorization on patient care can be severe. A third of physicians have seen a patient in their care experience a serious adverse event due to prior authorization. This can include hospitalization, life-threatening events, or permanent bodily damage/death.

On a similar theme: Ambetter Absolute Total Care Prior Authorization Form

The US healthcare system is spending a staggering $35 billion each year on administrative costs for prior authorization.

This is a significant financial burden, not just for patients, but also for healthcare providers and the system as a whole.

Handling prior authorizations costs $11,000 per clinician per year, which includes support staff like PAs and NPs.

Practices are also feeling the pinch, with costs ranging from $20 to $30 per prior authorization submission.

The average practice submits around 45 prior authorizations weekly, which can add up quickly.

Here are some key statistics on the cost and effectiveness of prior authorization:

Reform efforts are underway to address the complexities of prior authorization.

The American Medical Association (AMA) is working with state medical associations to achieve prior authorization reforms using AMA model legislation and other resources.

CMS issued a final rule earlier this year that will reduce patient care delays and administrative burdens on physicians by right-sizing the prior authorization process imposed on medical services and procedures by Medicare Advantage and other government-regulated plans.

Suggestion: Ama Prior Authorization Survey

Health plans will be required to offer electronic prior authorization technology that directly integrates with Electronic Health Records (EHRs), significantly reducing unnecessary burden for physicians.

This reform measure is expected to result in an estimated $15 billion in practice savings over 10 years, according to the U.S. Department of Health and Human Services.

CMS also issued a proposed rule to overhaul the prior authorization process, streamlining requests and sharing healthcare data more readily.

Under this proposed rule, state Medicaid agencies and Medicare Advantage plans would be required to improve their prior authorization processes and respond to requests more quickly.

If this caught your attention, see: Health Plans Inc Prior Authorization

The AMA is advocating for physicians and their patients against onerous prior authorization processes.

Physicians are fighting against these processes, often with fax machines as their only available tool, which can lead to delays or denials of treatment plans.

Nearly one in four physicians surveyed said prior authorization led to a serious adverse event for a patient in their care.

More than three-fourths of respondents said prior authorization can lead to patients abandoning treatment.

Over nine in ten physicians reported that prior authorization negatively affects clinical outcomes for their patients.

The consequences of prior authorization include greater physician burnout, reduced employee productivity, and significant costs incurred across the entire health care system.