As COVID-19 peaked, the harmful burdens of prior authorization continued

What are the news: Nearly 70% of physicians report that health insurance plans have never relaxed their preliminary authorisation requirements to help alleviate burdens during the pandemic, or payers did so temporarily before returning to the status quo.

The discouraging conclusion is among many included in the AMA latest survey of pre-approved physicianswhich was conducted at the height of the COVID-19 pandemic in December 2020 and released this month.

“As the COVID-19 pandemic began in early 2020, some commercial health insurers have temporarily relaxed prior authorization requirements to reduce administrative burdens and support timely patient access to needed drugs, tests and treatments. “, said the president of the AMA. Susan R. Bailey, MD. “At the end of 2020, as the U.S. healthcare system was strained with a record number of new COVID-19 cases per week, the AMA found that most physicians faced hurdles in strict authorizations that delayed patients’ access to necessary care.”

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Why it matters: The weekly pre-authorization workload for a single physician does not just eat up an average of two working days of physician and staff time, the survey shows. The process also negatively affects patient care, with 94% of physicians reporting delays in care while waiting for health insurers to authorize needed care, and 79% saying patients drop out of treatment due to authorization difficulties with insurers. disease.

“Treatment delayed and interrupted due to an archaic prior authorization process can have life-threatening consequences for patients, especially during a public health emergency,” Dr. Bailey said. “This hard-learned lesson of the current crisis must guide a re-examination of the administrative burdens imposed by health insurers, often without any justification.”

Indeed, 90% of physicians said prior authorization requirements had a negative effect on patient clinical outcomes, with 30% saying the requirements resulted in a serious adverse event for a patient in their care. Specifically, prior authorization requirements have resulted in the following impacts for patients:

  • Hospitalization of patients — reported by 21% of physicians.
  • Life-threatening event or procedure to prevent permanent impairment or damage – reported by 18% of physicians.
  • Disability or permanent bodily harm, birth defect, birth defect, or death — reported by 9% of physicians.

Meanwhile, only 15% of physicians said prior authorization criteria were often or always based on evidence-based medicine.

The findings of the AMA survey illustrate a critical need to streamline or eliminate low-value prior authorization requirements to minimize delays or disruptions in the delivery of care. WADA has played a leading role in advocating for prior authorization reforms and convening key industry stakeholders to develop a roadmap to improve the prior authorization process.

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Learn more: In 2018, the AMA and other national organizations representing pharmacists, medical groups, hospitals and health plans signed a consensus statement outlining a shared commitment to improving five key areas associated with the prior authorization process. However, health plans have made little progress over the past three years toward implementing improvements in each of the five areas outlined in the consensus statement.

Through research, collaborations, advocacy and leadership, the AMA works to scale prior authorization programs right so doctors can focus on patients, not paperwork. Patients may share their own personal experiences with prior permission to FixPriorAuth.org.

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