Docs slam prior authorization inertia, with hundreds claiming it’s led to patient harm

Physicians this week are slamming health insurers’ inability to improve cumbersome prior authorization policies and insist legislative action is now needed to address the issue.

A new survey of 1,000 docs found that nearly one-quarter reported that these utilization-management techniques have led to adverse events for their patients. Another 16% said prior authorization resulted in a patient’s hospitalization, the American Medical Association reported Tuesday.

AMA noted that the findings come years after payer industry leaders signed a “landmark” document, signaling commitment to reform PA policies.

“These new survey results 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. Even more concerning, this process can harm our patients,” AMA President Susan Bailey, MD, said in a statement. “Almost two and a half years after our consensus statement, the sad fact is little progress has been made toward the reform goals.”

A bipartisan group of legislators—including two physicians—have introduced new policy that would begin to tackle these issues. HR 3107, those involved said, would require Medicare Advantage plans to streamline and standardize PA, along with improving transparency. More than 219 members of the House have now cosponsored the bill.

“My legislation will go a long way in addressing what this survey makes clear—physicians and other healthcare professionals are spending too much of their time dealing with burdensome and archaic prior authorization requests when they should be caring for people,” Rep. Suzan DelBene, D-Wash., said in the AMA statement.

The doc group conducted the 31-question online serving over the web in December. About 40% of those responding work in primary care while the other 60% deliver specialty services. On average, practices said they complete 33 PAs requests each week, and 30% said they have staff dedicated solely to this work.

Prior authorization has served as a key area concern for radiologists in recent years, as insurers have added extra obstacles to avoid covering imaging exams. Back in April—following encouragement from the American College of Radiology and others—the federal government asked Medicare Advantage plans to pause PA during the pandemic. ACR also urged major commercial payers to do the same, a request that Cigna later declined.