Physician Frustration With Prior Authorizations Hits New High

June 09, 2017 03:20 pm News Staff

The topic of prior authorizations is heating up as physicians and the medical organizations that represent them attempt to rein in such requests from health insurance companies.

[Stethoscope on top of medical files]

Less than a week after the AAFP unveiled its new policy on prior authorizations, the Medical Group Management Association (MGMA) released polling results that reveal the growing extent of the problem.

Specifically, in a recent Stat poll conducted in mid-May, 86 percent of respondents said that prior authorization requests -- and other requests from health plans asking for supporting documentation on patients -- had increased in the past year.

That's an increase of 4 percentage points from the previous year, when a similar poll was taken.

Of the 1,041 applicable responses (out of a total of 1,095 responses) from medical practice leaders around the country, just 3 percent said such requests were decreasing, and 11 percent said the number of requests was about the same as in 2016.

As noted in an MGMA release about the poll results(www.mgma.com) -- and as practicing family physicians know all too well -- the excessive amounts of energy and resources physicians and other clinical staff spend on addressing insurance company preauthorization requests take time away from patient care.

"Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications and medical devices ceaselessly question the judgement of physicians, resulting in less time to treat patients and needlessly driving up administrative costs for medical groups," said MGMA President and CEO Halee Fischer-Wright, M.D., in the press release.

The AAFP's prior authorization policy states similar objections: "The very manual, time-consuming processes used in prior authorization programs burden family physicians, divert valuable resources away from direct patient care and can inadvertently lead to negative patient outcomes."

It's no surprise that the two organizations are very much in sync on this topic. Both were part of a coalition of 17 organizations that included the AMA, the American College of Cardiology and the American Hospital Association that worked together to create a set of 21 principles(www.ama-assn.org) aimed at reducing the burden that excessive preauthorization requests put on physicians.

That document, titled "Prior Authorization and Utilization Management Reform Principles," was released in January.

Related AAFP News Coverage
Medical Organization Coalition Calls for Prior Authorization Reform
AAFP Also Drafts Policy on Requirements

(1/26/2017)