Advocacy Update

June 26, 2020: Advocacy spotlight on Prior auth survey findings underscore need for legislative action


Nearly a quarter of physicians (24%) say that the prior authorization (PA) process has led to a serious adverse event for a patient in their care, according to an AMA survey of 1,000 practicing physicians.

Additionally, 16% of the physicians surveyed report that PA has led to the hospitalization of a patient. Other adverse events include disability or permanent bodily damage, other life-threatening events and in some cases death.

"These new survey results (PDF) highlight that practices continue to devote significant time—an average of nearly two business day per week per physician—navigating prior authorization's administrative obstacles," said AMA President Susan R. Bailey, MD. "Even more concerning, this process can harm our patients."

PA is a health plan utilization-management or cost-control process that requires physicians to obtain approval before a prescribed treatment, test or medical service qualifies for payment. The AMA offers prior authorization resources to support reform, improve practice efficiency and provide data to highlight the need for change.

"The prior authorization process became indefensible years ago," Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), said during a speech at the AMA National Advocacy Conference in February. "Patients are frustrated, and doctors are sick of pointlessly wrangling with insurance companies."

More than nine in 10 (91%) respondents to the AMA survey report that PA delayed access to necessary care, 90% note that PA has a negative impact on clinical outcomes and 74% say PA delays have led to patients abandoning their recommended course of treatment.

On average, physician practices complete 33 PA requests per physician, per week, a workload that chews up 14.4 hours of physician and staff time as they fax and refax PA requests or wait on hold for a response instead of delivering patient care. Almost one third (30%) of respondents report having practice staff who exclusively work on PA processing, and 86% describe the administrative burden associated with PA as "high" or "extremely high."

The survey results also show that PA burdens are growing. A majority of physicians (87% and 82%, respectively) report an increase in the volume of prior authorizations for prescription drugs and medical services over the past 5 years. Additionally, 86% of survey respondents say the burden associated with PA has gotten worse in the past 5 years. Read more.