Physician Practices Say Prior Authorization Issues Worsening: Poll

A new survey from the Medical Group Management Association (MGMA) indicates that 79% of practices say that prior authorization requirements have increased over the past 12 months. Another 19% say there has been no change, and a mere 2% reported that such requirements have decreased.

Practices were particularly troubled by a lack of response or slow response times from payers, an increase in the amount of time staff must spend working on prior authorizations, and a lack of automation in payers' prior authorization processes. The survey's 644 respondents from US medical groups pointed out that delays in authorizations create delays in patient care.

"Constantly changing medical necessity requirements and appeals processes...often result in dangerous delays to patient care and unnecessary increases in administrative overhead," Anders M. Gilberg, MGMA's senior vice-president for government affairs, said in a statement accompanying the release of the data.

In a similar survey released in 2021 by the American Medical Association, 82% of physicians surveyed said that issues related to the prior authorization process could sometimes lead to patients abandoning their recommended course of treatment, and 34% said that prior authorization troubles had led to a serious adverse event for a patient in their care.

Overall Burden

The MGMA's 2021 Annual Regulatory Burden Report, released this past October, found that 91% of medical practices said their overall regulatory burden had increased in the prior 12 months, and 95% said a reduction in red tape would allow them to reallocate resources toward patient care.

While prior authorization topped this list, with 88% of respondents saying these requirements were "very or extremely burdensome," other regulatory headaches ranked high as well. Both COVID-19 workplace mandates and the Medicare Quality Payment Program were cited as "very or extremely burdensome" by 71% of practices, while 60% ranked Medicare Advantage chart audits at the top of the scale.

The problem is not always the requirements themselves, though. One respondent to the MGMA's 2021 poll remarked that many of these requirements "would not be so burdensome if government agencies would communicate openly and transparently about how to comply."

Prior authorization, however, was seen as particularly maddening, with one respondent saying, "The requirements and inconsistencies have repeatedly delayed care and have required us to hire additional staff simply to keep up with the ever-changing prior authorization environment."

Legislative Relief

The issue of prior authorization is getting some attention on Capitol Hill.

A bipartisan and bicameral bill, The Improving Seniors' Timely Access to Care Act of 2021, introduced in the House in May by Representative Suzan DelBene (D-Wash), and in the Senate in October, has garnered more than 240 co-sponsors and the support of over 400 organizations. The legislation would, among other improvements, increase transparency, establish a national standard for clinical documents, and streamline the prior authorization procedure by creating an electronic system for processing approvals and denials.

On February 10, in a statement responding to the American Medical Association survey on prior authorizations, Representative DelBene said, "The data is clear that the prior authorization status quo delays care, worsens health outcomes, and is an additional barrier for seniors, families, and medical providers. We need to bring this practice into the 21st century."

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Cite this: Avery Hurt. Physician Practices Say Prior Authorization Issues Worsening: Poll - Medscape - Mar 04, 2022.