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Wednesday | 9.20.2017
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Insurer Preauthorization Policies Diminish Patient Care, AMA Survey Finds

Policies that require physicians to ask permission from a patient’s insurance company before performing a treatment negatively affect patient care, according to a survey released by the American Medical Association (AMA). The association says this was its first national physician survey to quantify the burden of insurers’ preauthorization requirements for a growing list of routine tests, procedures and drugs.

“Intrusive managed-care oversight programs that substitute corporate policy for physicians’ clinical judgment can delay patient access to medically necessary care,” said AMA Immediate Past President J. James Rohack, M.D. “According to the AMA survey, 78% of physicians believe insurers use preauthorization requirements for an unreasonable list of tests, procedures and drugs.”

The AMA survey of about 2,400 physicians indicated that health-insurer requirements to preauthorize care have delayed or interrupted patient care, consumed significant amounts of time, and complicated medical decisions. Highlights from the AMA survey include these:

* More than one-third (37%) of physicians experienced a 20% rejection rate from insurers on first-time preauthorization requests for tests and procedures. More than half (57%) of physicians experienced a 20% rejection rate from insurers on first-time preauthorization requests for drugs.

* Nearly half (46%) of physicians had difficulty obtaining approval from insurers on 25% or more of preauthorization requests for tests and procedures. More than half (58%) of physicians had difficulty obtaining approval from insurers on 25% or more of preauthorization requests for drugs.
 
* Nearly two-thirds (63%) of physicians typically waited several days to receive preauthorization from an insurer for tests and procedures, while one in eight (13%) waited more than a week. More than two-thirds (69%) of physicians typically waited several days to receive preauthorization from an insurer for drugs, while one in 10 (10%) waited more than a week. 
 
* Nearly two-thirds (64%) of physicians reported difficulty in determining which tests and procedures required preauthorization by insurers. More than two-thirds (67%) of physicians reported difficulty in determining which drugs require preauthorization by insurers.
 
Preauthorization policies deliver costly bureaucratic hassles that take time from patient care, according to the AMA. Physicians spend 20 hours a week on average just dealing with preauthorizations and studies show that navigating the managed-care maze costs physicians $23.2 billion to $31 billion a year, according to the organization.

"Nearly all physicians surveyed said that streamlining the preauthorization process is important, and 75% believe an automated process would increase efficiency,” Dr. Rohack said. “The AMA is urging health insurers to automate and streamline the current cumbersome preauthorization process so physicians can manage patient care more efficiently.”


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