AMA: Poor Prior Authorization Outcomes Are Negatively Affecting U.S. Health

While it is clear that prior authorization delays and denials are bad for your organization’s bottom line, the American Medical Association has released a survey of 1,000 practicing physicians that indicates they also have a significant negative impact on patients clinical outcomes.

Perhaps most concerning among all the survey data is the fact that 28 percent of responding physicians reported that Prior Authorization delays or denials led to a serious adverse event — death, hospitalization, disability/permanent bodily damage, or other life-threatening events — for a patient in their care.

In other words, prior authorization reform is not just about money, it’s about lives.

The Numbers

The delays are considerable and widespread. When physicians were asked how long their staff waited for a prior authorization decision from health plans, 65 percent said they waited at least one business day for prior authorizations, and nearly 30 percent said they had waited three business days or longer. Now consider the fact that it takes the equivalent of two business days of physician and staff time to complete each of the 31 prior authorization requirements they see every week.

In addition, 84 percent of physicians said the burdens associated with prior authorization were “high” or “extremely high,” and 86 percent believe burdens associated with prior authorization have increased during the past five years.

Unsurprisingly, more than 90 percent of physicians reported prior authorization requirements had a negative impact on patient clinical outcomes and those prior authorization procedures held up patient access to necessary care.

“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care,” Jack Resneck, Jr., MD, AMA chair said in a press release.

In short, these delays and denials are negatively affecting the health of patients in a significant and measurable way. While a coalition led by the AMA launched a campaign to reform Prior Authorization requirements in 2017, little has been accomplished. However, one tactic that everyone can agree on is an industry-wide adoption of an automated prior authorization solution such as the Infinx Prior Authorization Software.

“The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality health care they need,” Resneck, Jr, said.

Prior Authorization Problems and Reform

Prior authorization requirements can delay the start or continuation of necessary treatment and negatively affecting patient health outcomes. These manual, time-consuming processes burden providers and divert valuable resources from direct patient care. Yet health plans and benefits managers argue that prior authorization requirements are necessary to control costs and ensure appropriate treatment.

Two years ago, a coalition led by the AMA urged an industry-wide reassessment of prior authorization programs to align with a newly created set of Prior Authorization and Utilization Management Reform Principles.

Among those principles is a call to adopt a standardized electronic prior authorization transactions that saves patients, providers and utilization review entities significant time and resources and can speed up the care delivery process. More than 100 other health care organizations have supported those principles.

Yet, despite the AMA’s best efforts, the recent physicians poll indicates that calls for health care reform that makes the patient-physician relationship more valued than paperwork have failed to produce a significant impact.

A Prior Authorization Solution Today

Fortunately, Infinx’s Prior Authorization Software is a solution that quickly and effectively solves 100 percent of your prior authorization headaches, saving money and eliminating unnecessary negative patient outcomes.

The software optimizes your prior authorization workflow, minimize denials, and maximizes turnaround time. Exceptions are automatically routed to a team of trained, certified prior authorization specialists, who can successfully complete your request on time. Automating your workflows ultimately frees physician and office staffs time to focus on billable patient care.

We don’t want you to just take our word for it though. Schedule a demo today and learn how our prior authorization software solution can simplify your workflow and increase cash flow.

About the Author

Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

Leave A Comment



Subscribe to our monthly newsletter for industry updates on prior authorization and RCM.

Speed Up Prior Authorizations Using Automation and Artificial Intelligence

Accelerate your approvals, collect more revenue, and improve the patient experience

Schedule a Demo