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- Physicians Faced Burdens from Prior Authorization During Pandemic: AMA Survey
As new cases of COVID-19 were peaking in late 2020, most physicians reported that health plans continued to impose prior authorization policies that delay access to necessary care, according to new survey results by the American Medical Association (AMA). The CAP has worked with the AMA to address programs requiring prior authorization because they can negatively affect patient access to necessary diagnostic tests, create inconsistencies with current clinical practice, and increase burdens on pathologists and laboratories.
According to the AMA survey, almost 70% of 1,000 practicing physicians surveyed in December of 2020 reported that health insurers had either reverted to past prior authorization policies or never relaxed these policies in the first place. More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care. Nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.
Additionally, nearly one-third (30%) of physicians reported that prior authorization requirements have led to a serious adverse event for a patient in their care. More specifically, prior authorization requirements led to the following repercussions for patients:
- Patient hospitalization—reported by 21% of physicians
- Life-threatening event or intervention to prevent permanent impairment or damage—reported by 18% of physicians
- Disability or permanent bodily damage, congenital anomaly, birth defect, or death—reported by 9% of physicians
The findings of the AMA survey demonstrate a need to streamline or eliminate low-value prior-authorization requirements. In January 2018, the AMA, the CAP, and other health care organizations signed a consensus statement outlining a shared commitment to improving five key areas associated with the prior authorization process. However, health plans have made little progress in the last three years toward implementing improvements in each of the five areas outlined in the consensus statement.