Docs Rebel Against Prior Authorization / by F. Perry Wilson

Prior authorization gets terrible reviews from practicing doctors, in a wakeup call to the insurance industry.

Do you remember the days when you could write a patient a prescription, and they'd take it to the pharmacy, and actually receive the medication? I don't, because my entire professional career has been conducted under the cloud of prior authorization, but I like to imagine an idyllic past where I was allowed to, you know, treat the patient as I thought would be best.

A new survey from the American Medical Association, examining the attitudes of 1000 physicians regarding prior authorization has results that will come as no surprise to health care practitioners, but should serve as a wake-up call for the insurance industry; docs are not happy.

Prior authorization is frequently characterized by insurance companies as an effort to deliver the best possible therapy to the patient and to avoid unnecessary care, but many physicians I've spoken with seem to think it is simply a tactic to make expensive care more onerous, driving down the costs to the insurance companies.

The AMA survey is the first to characterize the feelings on prior authorization across a broad swath of physicians and the results are quite disturbing.

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84% of the docs surveyed reported that their prior auth burden was high or extremely high.

And 86% reported that the burden has increased over the past five years. The cohort reported needing to request prior auths 29.1 times per week and dedicate an average of 14.6 hours a week just to that practice.

79% reported often having to repeat prior auths even for patients who are on a stable, previously-approved regimen.

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Does it impact patients? The physicians think so, with 78% reporting that prior auth can at least sometimes lead to treatment abandonment.

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Now – let's give some caveats here. This is self-reported data, and physicians who are angry about prior auths have every incentive to inflate the burden they report; no one was verifying these claims directly.

Let's also understand that insurers really do have a role in constraining out-of-control medical costs, and prior auth is one tool in that armamentarium. Some care really is inappropriate.

The bottom line is this: If insurers really just want to make sure that care is appropriate, make it easy for us to prove that the care is appropriate – integrate prior authorization into the electronic medical record, make it fast, and give results before the patients leave our offices.

But if the intention is not to avoid inappropriate care, but to avoid costly care even if it's appropriate, than the current strategy of throwing up meaningless roadblocks seems to be working.

In the end, it's ok that prior authorization exists. But there is a right way to do it. And from this data we can see that the way it works now is not the right way.

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