Prior authorization, denials contribute to clinician burnout, AHA says

Commercial health plans are abusing practices like prior authorization and claim denials, leading to more burnout among clinicians and barriers to care for patients, the American Hospital Association said in a Dec. 2 report

For the analysis, the association surveyed more than 200 hospitals and health systems in 2019 about how commercial insurers' prior authorization and denial practices affect their operations. In addition to the survey data, the association interviewed and held group discussions with several hundred additional hospital and health system executives.

While the analysis includes findings from before the COVID-19 pandemic, the association said staffing shortages brought on by the pandemic have made addressing prior authorization and denial issues "increasingly urgent." 

Among the report's findings, the association said overuse of prior authorization and denials often leave patients surprised by unexpected medical bills. The association added that the extra steps nurses and physicians have to go through to get approval for procedures "adds billions of wasted dollars to the healthcare system and contributes to clinician burnout," citing a 2019 JAMA study.

In one instance, the association found a 17-hospital system spends $11 million each year trying to comply with health plan prior approval requirements. Physicians also reported that each week, their offices spend two business days on average addressing prior authorizations. Eighty-nine percent of the physicians said their burden level with the task was high or extremely high.

Becker's Hospital Review reached out to America's Health Insurance Plans, the commercial health insurance industry's largest trade group, for comment on the report. AHIP spokesperson David Allen said health plans "understand the importance of reducing administrative burdens so providers can spend more time with their patients."  

He cited an AHIP survey that found most health insurers are taking steps to streamline the prior authorization process, and that more than 90 percent of commercial enrollees are in plans that limit prior authorization to less than a quarter of medical services.

"Health insurance providers remain committed to simplifying processes to improve the care experience while ensuring that patients receive the safe, affordable care they deserve," Mr. Allen said.

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