Prior authorization is 'wreaking havoc': AMA survey

Prior authorization is "wreaking havoc" on patient outcomes, physician burnout and productivity, a recent American Medical Association survey found.

The survey was conducted in December and asked 1,000 physicians — 400 in primary care and 600 specialists — about prior authorization and its impact on patients, clinicians and unnecessary spending.

More than 1 in 3 physicians said they believed the prior authorization criteria is rarely or never evidence based.

Here are 19 findings of the effects on patients and physicians.

Impact on patients

Ninety-four percent of respondents reported prior authorizations create delays in care.

Prior authorization sometimes leads to treatment abandonment, with 22% reporting it happens often.

Twenty-four percent of physicians reported prior authorization led to adverse events: 19% reported it led to patient's hospitalization, 13% reported it led to life-threatening events or required intervention to prevent permanent impairment or damage and 7% reported that it led to a patient's disability, birth defect or death.

Seventy-nine percent of respondents said prior authorization at least sometimes leads patients to pay for medication out of pocket.

Impact on physicians

The average practice completes 43 prior authorizations per physician, per week. Physicians and staff also report spending about 12 hours per week completing such paperwork.

Thirty-five percent of physicians said they have staff who exclusively work on prior authorizations.

Twenty-seven percent of physicians reported that their prior authorizations are often or always denied, and 95% of physicians said it contributes to burnout.

Eighteen percent of physicians said they always appeal the decision, but most do not because they believe it will not be successful based on experience.

Most physicians (87%) reported that prior authorizations led to higher overall utilization, including ineffective initial treatment (69%), additional office visits (68%). Immediate care or emergency department visits (42%) and hospitalizations (29%).

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