Is Prior Authorization Causing Problems?

Is Prior Authorization Causing Problems?

- February 21, 2018

Prior authorizations for health insurance companies have been a source of complaint among physicians for years, but never before have the number of complaints been so high.

In September of 2016 the AAFP revealed it’s new policy on prior authorizations. Shortly thereafter the Medical Management Association or (MGMA) released polling results that showed these two organizations were united against wasting time and money on preauthorization.

In mid-May of 2017 Stat conducted a poll that showed 86 percent of the respondents felt that prior authorization requests and other documentation for health plans had increased since the previous year. This is a 4 percent increase from a similar poll taken in 2016.

Only 3 percent of the 1,041 responses from medical practice leaders across America said that the requests were decreasing, and 11 percent reported that the number of requests had stayed relatively close to the same.

What’s the big deal? Some readers may be asking. As physicians know all to well a lot of (some would say too much) energy and resources are put into addressing insurance company authorization requests. Meaning patients suffer, because time is wasted, and nothing can be done until that authorization has occurred.

MGMA thoughts about these authorizations were revealed by MGMA President and CEO hale Fischer-Wright M.D. in a press release: "Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications and medical devices ceaselessly question the judgement of physicians, resulting in less time to treat patients and needlessly driving up administrative costs for medical groups,"

The AAFP’s new policy expressed similar sentiments “The very manual, time-consuming processes used in prior authorization programs burden family physicians, divert valuable resources away from direct patient care and can inadvertently lead to negative patient outcomes."”

Both the AAFP and MGMA are part of a coalition that created a set of 21 principles( that are devoted to lifting some of the burden off the physicians and helping them provide better patient care.


Written by Oracle RX Team

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