Unveiling the Impact of Prior Authorization on Patient Outcomes: Insights from Recent AMA Survey

December 1, 2023

In a recent survey conducted by the American Medical Association (AMA), physicians across the United States have voiced their concerns about the detrimental effects of prior authorization requirements on patient outcomes. The survey, conducted in December and featuring responses from 1,001 practicing physicians, sheds light on the challenges faced by both primary care physicians (40%) and specialists (60%).

Here are seven key takeaways from the survey:

  1. Delayed Access to Necessary Care:A staggering 94% of physicians reported that prior authorization has resulted in delayed access to essential medical care. This highlights a critical issue affecting the timely delivery of healthcare services.
  2. Negative Impact on Patient Outcomes:A significant 89% of physicians expressed that prior authorization requirements are linked to worse patient outcomes. This sheds light on the overarching impact of administrative processes on the overall well-being of patients.
  3. High Burden on Physicians:A substantial 88% of surveyed physicians stated that the burdens associated with prior authorization are either high or extremely high. Additionally, 35% of these physicians have dedicated staff specifically handling tasks related to prior authorization, emphasizing the resource-intensive nature of the process.
  4. Treatment Discontinuation:A concerning 80% of physicians reported instances where patients had to discontinue treatment due to issues arising from prior authorization processes with payers. This highlights the potential interruption in the continuity of care.
  5. Impact on Job Performance:For physicians providing care to working patients, 58% acknowledged that prior authorization had a noticeable effect on the patient's job performance. This underscores the broader implications of healthcare administrative hurdles on individuals' livelihoods.
  6. Serious Events with Patients:One-third of physicians revealed that prior authorization has led to serious events with patients. This includes hospitalization (25%), permanent impairment (19%), and, regrettably, even death (9%). These alarming statistics underscore the critical need for a streamlined and patient-centric approach to healthcare processes.
  7. Evidence-Based Criteria Concerns:Only 15% of physicians expressed confidence in payer's prior authorization criteria being often or always evidence-based. This suggests a potential gap between the criteria set by payers and the clinical realities faced by healthcare providers.

The findings of this survey highlight the urgent need for a reevaluation of prior authorization processes to ensure they prioritize patient well-being and streamline administrative burdens for physicians. As we navigate these challenges, it becomes increasingly evident that collaborative efforts are essential to create a healthcare system that truly puts patients first.