Prior authorizations are an obvious obstacle for physicians, but it also negatively impacts employers.
According to a news release from the American Medical Association (AMA), a survey of 1,004 practicing physicians found that 51 percent of respondents reported that the prior authorization process has interfered with their patients’ ability to perform their job responsibilities. A further 34 percent say that prior authorization has led to a serious adverse event such as hospitalization, disability, or even death for a patient in their care.
“Health insurance companies entice employers with claims that prior authorization requirements keep health care costs in check, but often these promises obscure the full consequences on an employer’s bottom line or employees’ well-being,” AMA President Gerald Harmon, MD, says in the release “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.”
A vast majority of respondents, 93 percent, say that they’ve had to delay care while awaiting health insurer authorization of necessary procedures. A further 82 percent of respondents say they’ve had patients abandon treatment because of struggles getting authorization from health insurers, the release says.
When asked how often prior authorization criteria is based on evidence-based science or guidelines national medical societies, 30 percent of respondents say that the criteria is rarely or never based on these things. Only 1 percent of respondents say that prior authorizations have had a somewhat or significantly positive impact patient clinical outcomes, according to the release.
“Now is the time for employers to demand transparency from health plans on the growing impact of prior authorization programs on the health of their workforce,” Harmon says.
Here are some tips physicians can use to limit the impact of prior authorizations on their practice:
This article was published by our sister publication Medical economics.