Prior Authorization Negatively Impacts Clinical Outcomes

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Sixty-four percent of respondents reported waiting at least 1 business day for a PA decision from health plans, with 30% waiting at least 3 business days.
Sixty-four percent of respondents reported waiting at least 1 business day for a PA decision from health plans, with 30% waiting at least 3 business days.

HealthDay News — The burdens associated with prior authorization (PA) are high and include a negative impact on clinical outcomes, reported by 92 percent of physicians, according to the results of a survey conducted for the American Medical Association (AMA).

The survey examined the experiences of 1,000 practicing physician (40 percent primary care physicians/60 percent specialists) with PA. Twenty-seven questions were administered in December 2017 in the web-based survey.

According to the results of the survey, 64 percent of respondents reported waiting at least one business day for a PA decision from health plans, with 30 percent waiting at least three business days. The PA process delayed care in 92 percent of cases; 78 percent of respondents reported that PA can at least sometimes lead to treatment being abandoned. 

Overall, 92 percent of respondents reported that PA can have a negative impact on patient clinical outcomes, with a significant negative impact reported by 61 percent. Eighty-four percent of physicians describe the burden associated with PA as high or extremely high for the physicians and staff in practice. Eighty-six percent reported an increase in PA burdens over the past five years.

"The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care," AMA chair-elect Jack Resneck Jr., M.D., said in a statement.

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