March 13, 2019
Dive Brief:
- The number
of prior authorization requirements has increased in the past five years
and 85% of physicians say the practice interferes with continuity of care,
according to a new survey from
the American Medical Association.
- Findings
from the survey of 1,000 physicians released Tuesday found that more than
two-thirds said it's difficult for them to determine whether a
prescription or service needs prior authorization. Fewer than 10% said
they contract with a health plan that allows programs that can exempt
providers from the requirement.
- Most prior authorizations are
obtained by phone or fax, according to the report. Just over 20% of
physicians said their EHRs allowed for electronic approvals, which
can be more efficient.
Dive Insight:
AMA
and groups like the American Academy of Family
Physicianshave argued that payers need to improve the prior
authorization process. In a statement released with the survey
findings, AMA charged insurance companies with a "year of
foot-dragging and opposition" to prior authorization reforms.
A
group of Michigan healthcare organizations came together and created Health
Can't Wait to protest prior authorizations. Critics of the
practice allege that requiring payers to approve certain services leads to
delayed and disrupted care.
However,
payers view prior authorizations as a vital cost control that limits
unnecessary care. Prior authorizations also have their supporters in
Washington. A Government Accountability Office report released in 2017 found that prior
authorization in Medicare saved as much as $1.9 billion through March
2017. The Trump administration's proposed budget also includes expanded
prior authorization measures for Medicare.
The
#TrumpBudget
includes 5+ new proposals to expand #PriorAuthorization
in Medicare. #PriorAuth
negatively impacts patient care and increases administrative costs. Who should
decide what's best for patients: your doctor or the govt? #LetDocsDecide
#MGMAAdvocacy
#FixPriorAuth
However,
providers complain that the process is burdensome and affects patient
care. The American Academy of Family
Physicians has called the practice family physicians'
"number one administrative burden."
Though
manual prior authorizations are considered cumbersome, electronic prior authorizations have
shown to speed the process and save money. Automating prior authorizations
reduces wait time for providers and patients and can lead to cost savings.
The Council for Affordable Quality Healthcare estimated
that electronic methods can save $6.84 per transaction.
Payers
understand there is a problem with manual prior authorizations. America's
Health Insurance Plans and the Blue Cross Blue Shield Association came together
with the AMA, American Hospital Association, American Pharmacists Association
and Medical Group Management Association. The groups released a "Consensus
Statement on Improving the Prior Authorization Process" last year.
The
groups agreed that reforms are needed. However, the latest AMA survey found
that providers haven't seen an improvement yet. The findings echo a February
AMA report that more than a quarter of physicians said
prior authorizations lead to "serious or life-threatening events."
In
a statement Tuesday, AMA President Barbara McAneny said prior authorizations
can work against people seeking treatment for opioid use disorder and that can
be deadly. "The AMA urges all health insurers to join with the
medical community to enact vital legislation that is an important step in
reversing the opioid epidemic," she said.
https://www.healthcaredive.com/news/ama-says-prior-authorizations-increasing-interfering-with-care-continuity/550342/
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