Insurance required prior authorization “wreaks havoc on patient care,” according to a recent release from the American Medical Association.
In addition to this conclusion, the physician organization’s 2023 survey found prior authorization was responsible for care delays in nearly every instance and treatment abandonment for nearly four out of every five patients.
Patients with Chronic Conditions Languish While Waiting
An ever-increasing number of innovative, effective treatments have been met with insurers’ attempts to manage and limit patients’ access to them. But this effort has serious consequences for patients:
- For people who live with migraine, the wait for insurance approval can be especially excruciating as they continue to experience debilitating symptoms like head pain, nausea and visual aura.
- For those with rare cancers, even two weeks’ wait for authorization means continued disease progression, and potentially fewer treatment options than if care could have been initiated immediately.
Regardless of condition, the one in four physician respondents to the AMA survey indicated that prior authorization “has led to a serious adverse event for a patient in their care.” Adverse outcomes included hospitalization and life-threatening events up to permanent disability, even death.
Doctors Spend 14 Hours Per Week on Prior Authorization
Given such high stakes, it’s no wonder physicians invest so much of their energy into completing the required paperwork as completely and timely as possible.
Yet, it’s a torturous process for health care professionals, one cited as a top contributor to burnout. They are, after all, trying to justify their expert medical opinion to someone who is only looking after the bottom line.
The hours diverted from patient care have a quantifiable cost to the health care system. Physicians devote upwards of $26.7 billion in time annually to navigating insurance requirements on behalf of their patients. And this doesn’t include the value of the staff members that 35% of physicians reported employing to work exclusively on tasks associated with prior authorization.
Denials Spur Calls for Reform
Despite the investment of resources on their end, 27% of physicians indicated that prior authorization requests are often or always denied.
Given the rates of denials, it’s no wonder Congressional efforts to streamline prior authorization requirements for Medicare Advantage items and services have been well received. It’s time for patients, caregivers, providers and advocates to jointly call for prior authorization reforms at every level for public and private insurers alike.