More than two-thirds of physicians reported that they have had to wait several days for insurers to conduct prior authorization reviews for tests, procedures, and prescription drugs, and about the same proportion said they have had difficulty tracking which of these therapeutics are subject to review requirements, according to a national survey of physicians released by the American Medical Association on Nov. 22.
Although physicians are frequently said to be frustrated by insurers’ review requirements, this is the AMA’s first national survey to measure physicians’ experiences. The survey of 2,400 practitioners was conducted in May.
Nearly all physicians would like to eliminate impediments caused by preauthorization requirements, with 78% saying it is "very important" and an additional 17% saying it is "important" for insurers to eliminate preauthorization hassles.
Part of the survey dealt specifically with prior authorization for prescription drugs, a common tool used to control utilization of high-cost drugs, especially when lower-cost alternatives are available.
Among the findings were the following:
• More than half (58%) of physicians experienced difficulty with obtaining approval from insurers on a quarter or more of preauthorization requests.
• In all, 57% experienced a 20% rejection rate on first-time preauthorization requests.
• Just under 40% reported appealing 80% or more of insurer rejections on first-time preauthorization requests.
The survey results showed that prior authorization "negatively impacts patient care," according to the AMA. "Intrusive managed care oversight programs that substitute corporate policy for physicians’ clinical judgment can delay patient access to medically necessary care," AMA Immediate Past President J. James Rohack said in a statement.
Physicians spend about 20 hr/wk, on average, dealing just with preauthorizations, according to the survey. Many physicians surveyed (75%) expressed a desire for plans to implement an automated preauthorization process to help them manage patient care more efficiently.
Scott Steinke is a writer for "The Pink Sheet." This news organization and "The Pink Sheet" are owned by Elsevier.