Physician Practice

Physicians want change in prior authorization policies

Physician Practice Insider, August 21, 2017

The growing demands of administrative work are a major pain point for most physician practices. These tasks include the daily grind of filing prior authorization (PA) requests for basic things like prescriptions and medical procedures, a time-draining process the AMA and other groups are looking to reform.

Physicians and analysts say filing PA requests makes sense for insurers when the requests involve elective surgeries, expensive procedures, or costly prescriptions. But the AMA, the American Academy of Family Physicians, and the Medical Group Management Association (MGMA) say the volume of PA requests has increased in the past few years to such a degree that the requests get in the way of providing timely care for patients.

“More than 25% of physicians say they have to wait an average of three business days to get a response from insurers for a prior authorization,” says Jack Resneck, MD, a member of the AMA board of trustees and a vice chair and professor of dermatology at the University of California, San Francisco. “It’s frustrating for patients and frustrating for physicians, who often have to file a follow-up request if the first PA request is denied, which is often the case.”


Survey results 

A survey commissioned by the AMA in December 2016 showed just how much time practices are spending each week on PAs. The online survey of 1,000 physicians found the average practice filed 37 PA requests per week in 2016, requiring an average of 16.4 hours per week to complete. It also found that 23% of practices filed more than 40 requests a week.

According to the survey, 75% of physicians said that filing PA requests places a “high” or “extremely high” burden on their practices. The survey also drilled down to determine how these requests impact staff time and provision of timely patient care. It found that 90% of practices said that filing PA requests delays access to care for patients, while 44% of practices said PAs “often” or “always” result in delayed care.

The survey also asked physicians to estimate the average amount of time it takes for a health plan to respond to a PA request after it is filed, with two-thirds of physicians reporting that health plans take anywhere from one to five business days to do so. On the high end, 6% said it takes more than five business days on average to receive an answer from a health plan on a PA request. The remainder said that it typically takes between one hour and one business day to hear back from insurers.

Practices also reported that they are often required to file multiple PA requests for prescriptions for the same patient. The survey found that 80% of physicians report having to file PA requests for prescription refills for patients who are receiving medications for a chronic condition, a key area the AMA addresses in its proposed reforms. 

The AMA survey also found that, in addition to requiring practices to make PA requests for routine procedures, the requests are filed and received in an antiquated manner. The survey found that requests are most commonly filed via fax or over the phone—both methods that interrupt the workflow at most practices, where nearly all data is now filed and stored in computers or mobile devices. 


This article was originally published in Physician Practice Perspectives.

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