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Prior authorization demands are getting worse, survey finds

Most said authorization requirements have increased over the past year. Healthcare practices and doctors say the process is hurting patient care.

Healthcare organizations and doctors are saying the demands of prior authorization are becoming more onerous.

A new survey released by the Medical Group Management Association found nearly 4 in 5 respondents (79%) said prior authorization requirements increased over the past year. Another 19% of participants said the requirements stayed the same. Only 2% said they saw fewer requirements in prior authorization.

Insurers require prior authorization before healthcare providers can prescribe a host of drugs, services and treatments for patients. For insurers, prior authorization is viewed as a tool to help reduce costs and treatments and services that may not be necessary.

Most healthcare providers detest the process. Healthcare organizations and physicians says it’s time-consuming and siphons money and manpower that could be used for treating patients.

Anders Gilberg, senior vice president of government affairs for the MGMA, said Thursday the mounting headaches of prior authorization need to be addressed.

“These onerous prior authorization requirements present medical groups with a variety of obstacles — including issues submitting documentation through non-standardized health plan web portals, as well as constantly changing medical necessity requirements and appeals processes — and often result in dangerous delays to patient care and unnecessary increases in administrative overhead,” Gilberg said in a statement.

“MGMA is once again calling on Congress to pass legislation that would reduce the overall volume and burden of prior authorization requirements, allowing medical groups to focus on delivering high-quality care to the patients they serve.”

The American Medical Association has been pushing for reform in the prior authorization process as well. The AMA releases an annual survey on prior authorization. In the AMA’s latest poll released in February 2022, most doctors say the process is impeding patient care. Nearly all doctors (93%) said prior authorization leads to delays in patient care, while 91% said it had a negative impact on patient outcomes, the AMA poll found.

In addition, most doctors (82%) said patients can be so frustrated by delays in getting approval that they sometimes abandon treatment.

Two out of five doctors (40%) said they have staff who work exclusively on prior authorization.

The AMA is also raising a new approach in its case for reducing the burdens of prior authorization by arguing that the process can lead to greater costs down the line. The groups says employers choosing health plans with excessive prior authorization requirements could see greater costs if delays in care means employees miss work or are less productive. More than half (51%) of doctors surveyed said prior authorization has interfered with their patients’ ability to do their work.

AMA President Gerald Harmon said prior authorization can hurt the bottom line of employers and worsen the health of workers.

“Benefit plans with excessive authorization controls create serious problems for employers when delayed, denied or abandoned care harms the health of employees and results in missed work days, lost productivity and other costs,” Harmon said in a statement.

Bureaucracy is a leading cause of burnout. A Medscape survey in January cited the amount of paperwork and bureaucratic tasks as the top cause of burnout among doctors.

Some healthcare advocates, including the Council for Affordable Quality Healthcare (CAQH), said automating the prior authorization process could save time and headaches. Its annual report, the 2021 CAQH Index, shows only 26% of prior authorization transactions were handled fully electronically. Many staff handle prior authorization requests by phone or fax. The MGMA wants to see more automation in prior authorization and is urging the adoption of industry-wide standards and operating rules. The group also is pushing for more transparency in prior authorization policies.

Overall, MGMA contends it's time to reduce the use of prior authorization on drugs and medical services.

The MGMA poll, released March 1, had 644 responses.


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