A survey conducted by the American Medical Association (AMA) finds physicians deeply frustrated by some of the prior authorization-related processes that they have to deal with on a day-to-day basis, with 24 percent reporting that prior authorization has led to a serious adverse event for a patient in their care, and with 93 percent of practicing physicians reporting that prior authorization has had a negative impact on patient clinical outcomes.
The results of the survey, entitled “2023 AMA Prior Authorization Physician Survey,” were released on June 18 in the form of a PDF report. The online survey was administered in December 2023, with 1,000 practicing physicians responding—60 percent of them specialists, 40 percent of them primary care physicians.
When asked about patients whose treatment requires prior authorization, 14 percent of respondents said that the prior authorization process “always” delayed access to necessary care; 41 percent said that it “often” did so, and 39 percent said that it sometimes did so. Five percent responded “rarely,” 1 percent didn’t know, and 0 percent responded “never.”
Significantly, 35 percent of physicians report that prior authorization criteria are rarely or never evidence-based.
As for appeals, 18 percent of physicians report that they always appeal an adverse prior authorization decision; but 48 percent report that they have insufficient practice staff resources or time to pursue appeals And 48 percent report that the patient care involved cannot wait for the health plan to approve the procedure or care.
What’s more 35 percent of respondents have staff members who work exclusively on prior authorization.
As for denials, 27 percent of physicians report that prior authorizations are often or always denied. What’s more, 73 percent report that denials have increased somewhat or significantly over the past five years, while another 21 percent say they’ve seen no change.
In a press release published on June 18, AMA president Bruce A. Scott M.D., stated that, “Across the country, physicians see firsthand the dangerous, harmful—and sometimes deadly—consequences of prior authorization. Payers erect roadblocks and hurdles allegedly designed to save money for the health system and protect precious resources, but when patients and their doctors face care delays—or even give up and abandon necessary care—the result can actually be increased overall costs when worsening health conditions force patients to seek urgent or emergency treatment. Our patients are caught in the middle, twisting in the wind, while physicians fight for them, often with fax machines as our only available weapon.”
Further, Dr. Scott said, “The time is now for Congress to adopt reintroduced prior authorization reform legislation that prioritizes patients’ access to care, reduces administrative burdens on physicians, and preserves resources for high-quality care. Because insurers will not change their ways despite their rhetoric, lawmakers have an important opportunity to rein in excessive prior authorization requirements and unnecessary administrative obstacles between Medicare Advantage patients and evidence-based treatments.”
