AMA survey indicates prior authorization wreaks havoc on patient care

The American Medical Association surveyed 1,000 practicing physicians asking 40 questions on prior authorization and the results show what members of the North Carolina Medical Society are saying:  Patient-Centered care is suffering because of barriers posed by prior auth.

One of the NCMS’s highest advocacy priorities is to reform prior authorization in North Carolina and team members have been actively working on HB649, an Act to Ensure Timely and Clinically Sound Utilization Reviews and that Medical Decisions are Made by Health Care Providers.  It was introduced in April, 2023.  Read more about it here.

NCMS VP of Advocacy John Thompson says “Efforts to reform prior authorization in North Carolina focus on reducing administrative burdens and ensuring timely access to necessary medical care. By streamlining the approval process and enhancing transparency between healthcare providers and insurers, the goal is to improve patient outcomes and support efficient healthcare delivery. These reforms aim to balance the need for cost control with the imperative to provide prompt and effective treatment.”

The AMA survey results are a detailed look at how prior auth is hurting patients.  Some of the results are:

  • Patient Harm—Nearly one in four physicians (24%) reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
  • Bad Outcomes—More than nine in 10 physicians (93%) reported that prior authorization has a negative impact on patient clinical outcomes.
  • Delayed Care—More than nine in 10 physicians (94%) reported that prior authorization delays access to necessary care.
  • Disrupted Care—More than three-fourths of physicians (78%) reported that patients abandon treatment due to authorization struggles with health insurers.
  • Lost Workforce Productivity—More than half of physicians (53%) who cared for patients in the workforce reported that prior authorizations had impeded a patient’s job performance.

Prior authorization is also, according to the survey, leading to increasingly burdensome administrative issues and an adverse impact on physicians:

“Across the country, physicians see firsthand the dangerous, harmful—and sometimes deadly—consequences of prior authorization,” wrote AMA President Bruce A. Scott, M.D. in a viewpoint that accompanied the AMA survey. “Payers erect roadblocks and hurdles allegedly designed to save money for the health system and protect precious resources, but when patients and their doctors face care delays—or even give up and abandon necessary care—the result can actually be increased overall costs when worsening health conditions force patients to seek urgent or emergency treatment. Our patients are caught in the middle, twisting in the wind, while physicians fight for them, often with fax machines as our only available weapon.”

To read the full survey results and see the methodology behind the survey click here.