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Skip to main content CONTINUE TO SITE ➞ * Deep Dive * Opinion * Library * Events * Topics Menu * Search * Sign up Search * Hospitals * Payer * Health IT * Government * Finances * Medical Groups * Telehealth * COVID-19 An article from Dive Brief MEDICAL GROUPS SAY PRIOR AUTHORIZATION BURDENS PERSISTED DURING PANDEMIC Published March 8, 2022 By Susan Kelly Contributor * * * * * DIVE BRIEF: * Among 644 medical practices in a new poll, 79% said insurers' prior authorization requirements had risen over the past year, according to the Medical Group Management Association. That's down from 90% that said prior authorization demands were increasing in the association's pre-pandemic survey conducted in September 2019. * Even so, another 19% of practices in the latest poll, conducted March 1, reported prior authorization requirements stayed the same in the past year, indicating the burdensome issue for doctors is not improving. Just 2% of medical practices said prior authorization obligations decreased in the past year, the MGMA Stat poll found. * The requirements are a major headache for medical groups. MGMA members surveyed in October rated prior authorization the top regulatory challenge they face, with 88% calling it "very" or "extremely" burdensome. DIVE INSIGHT: Health plans have been expanding the use of prior authorization as a tool to control costs for several years, to the frustration of physicians. MGMA members put the practice at the top of a list of burdensome issues that include COVID-19 workplace mandates, audits and lack of electronic health record interoperability, among other challenges. The administrative hurdles require medical practices to obtain authorization before providing treatments, tests or prescription drugs to patients. Physicians say the requirements not only delay patient care but also raise provider costs, by increasing time spent by staff to secure authorizations. Those challenges have been compounded during the pandemic by staffing shortages and intense competition for workers in the tightened labor market, MGMA said. Practices also report struggling with submitting documentation via fax or through a health plan's web portal, changing medical necessity requirements and appeals processes, and having to make multiple attempts to get patients the care they need, according to MGMA. The group said its members have been contending with escalating prior authorization requirements since 2016. That year, 82% of healthcare leaders polled reported an increase in the requirements from payers, with the percentage growing to 86% in a 2017 survey and 90% in 2019. The American Medical Association has made reducing prior authorization burdens a key priority of its advocacy efforts this year. The AMA believes that medically necessary clinical services and prescriptions covered by health insurance plans should be administered without delay, the group said in materials published in conjunction with a webinar on advocacy held last month. "Prior authorization undermines physicians' medical expertise and leads to considerable delays in patient care," the AMA said. A 2021 AMA survey found 93% of physicians reported care delays associated with prior authorization, and 82% said the requirements can sometimes cause patients to abandon treatment. The process is a contributing factor to physician burnout, the AMA said. In the worst case scenario, failure to administer medically necessary care can lead to poor health care outcomes, the group cautioned. "Most startlingly, 34% of AMA survey participants reported that prior authorization led to a serious adverse event, such as hospitalization, disability and permanent bodily damage, or death, for a patient in their care," the AMA said. The AMA's survey found physicians complete an average of 41 prior authorizations per week, and 40% of respondents said they hired staff to work exclusively on prior authorization requirements. Both the AMA and MGMA said they support legislation introduced in Congress that would increase transparency on Medicare Advantage prior authorization requirements, standardize processes for routine services and establish an electronic program for submitting documentation. * post * share * tweet * print * email Filed Under: Payer, Medical Groups HEALTHCARE DIVE NEWS DELIVERED TO YOUR INBOX Get the free daily newsletter read by industry experts Email: * Select Newsletter: Daily Dive Topics covered: M&A, health IT, care delivery, healthcare policy & regulation, health insurance, operations and more. M-F view sample * Select Newsletter: Payer Weekly Every Wednesday view sample * Select Newsletter: IT Weekly Every Thursday view sample * Select user consent: By signing up to receive our newsletter, you agree to our Terms of Use and Privacy Policy. You can unsubscribe at anytime. Sign up A valid email address is required. Please select at least one newsletter. EDITORS' PICKS * Megan Quinn/Healthcare Dive Deep Dive AS CROSS-STATE TELEMEDICINE WAIVERS EXPIRE, VIRTUAL CARE ADVOCATES FOCUS ON LONG-TERM POLICY CHANGES There’s a complication: No one solution to the U.S.’ patchy physician licensing infrastructure has universal buy-in. By Rebecca Pifer • June 21, 2022 * Explore the Trendline➔ Yujin Kim/Healthcare Dive Trendline PAYER/PROVIDER RELATIONSHIPS As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined. By Healthcare Dive staff GET THE FREE NEWSLETTER Subscribe to Healthcare Dive for top news, trends & analysis Email: * Select Newsletter: Daily Dive Topics covered: M&A, health IT, care delivery, healthcare policy & regulation, health insurance, operations and more. M-F view sample * Select Newsletter: Payer Weekly Every Wednesday view sample * Select Newsletter: IT Weekly Every Thursday view sample * Select user consent: By signing up to receive our newsletter, you agree to our Terms of Use and Privacy Policy. You can unsubscribe at anytime. Sign up A valid email address is required. Please select at least one newsletter. MOST POPULAR 1. Judge denies DOJ’s move to block $13B UnitedHealth, Change deal 2. Humana looks to buy clinics from private equity partner for up to $550M 3. Violence against emergency room physicians is on the rise, survey finds 4. Texas Medical Association files another lawsuit over surprise billing ban LIBRARY RESOURCES * Playbook How to Improve Employee Mental Health Care in a Real Way Custom content for Mentera * Infographic The Business Impact of Digital Transformation Custom content for Kyriba * Playbook Connectivity & Navigating What’s Next in Hospital Infrastructure Custom content for Verizon View all COMPANY ANNOUNCEMENTS * AllianceRx Walgreens Pharmacy Reduces Annual Patient Prescription Costs by $6 Million From AllianceRx Walgreens Pharmacy * Cardiovascular Associates of America Partners with Jeff Ozmon From Cardiovascular Associates of America * Cardiovascular Associates of America Welcomes Lori Jackson From Cardiovascular Associates of America * PharmaVoice names ‘Red Jacket’ honorees at virtual event From Industry Dive View all | Post a press release WHAT WE'RE READING * Kaiser Health News Shattered Dreams and Bills in the Millions: Losing a Baby in America * The New York Times Officials Hopeful That Monkeypox Can Be Eliminated in the U.S. * Associated Press 4.4M Americans roll up sleeves for omicron-targeted boosters View all EVENTS * 29 SEP Webinar | 2 p.m. ET How to Boost Healthcare Worker Engagement and Retention Presented by When I Work INDUSTRY INTEL * Delivering Exceptional Patient Care Through Quality Technology eBook • Provided by Keysight Technologies * Practical advice for digital health investments: 10 must-read articles Download • Provided by ServiceNow * Maximize Reimbursements: Rethink your strategy to transform your revenue Download • Provided by FinThrive HEALTHCARE DIVE NEWS DELIVERED TO YOUR INBOX Get the free daily newsletter read by industry experts Email: * Select Newsletter: Daily Dive Topics covered: M&A, health IT, care delivery, healthcare policy & regulation, health insurance, operations and more. M-F view sample * Select Newsletter: Payer Weekly Every Wednesday view sample * Select Newsletter: IT Weekly Every Thursday view sample * Select user consent: By signing up to receive our newsletter, you agree to our Terms of Use and Privacy Policy. You can unsubscribe at anytime. Sign up A valid email address is required. Please select at least one newsletter. COMPANY ANNOUNCEMENTS View all | Post a press release AllianceRx Walgreens Pharmacy Reduces Annual Patient Prescription Costs by $6 Million From AllianceRx Walgreens Pharmacy September 22, 2022 Cardiovascular Associates of America Partners with Jeff Ozmon From Cardiovascular Associates of America September 20, 2022 Cardiovascular Associates of America Welcomes Lori Jackson From Cardiovascular Associates of America September 13, 2022 PharmaVoice names ‘Red Jacket’ honorees at virtual event From Industry Dive September 16, 2022 Editors' picks * Megan Quinn/Healthcare Dive Deep Dive AS CROSS-STATE TELEMEDICINE WAIVERS EXPIRE, VIRTUAL CARE ADVOCATES FOCUS ON LONG-TERM POLICY CHANGES There’s a complication: No one solution to the U.S.’ patchy physician licensing infrastructure has universal buy-in. By Rebecca Pifer • June 21, 2022 * Explore the Trendline➔ Yujin Kim/Healthcare Dive Trendline PAYER/PROVIDER RELATIONSHIPS As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined. By Healthcare Dive staff Latest in Payer * Moody’s downgrades Envision, citing high bankruptcy risk By Susan Kelly * DOJ’s case against UnitedHealth’s Change buy was hampered by ‘serious flaws,’ judge finds By Samantha Liss * Texas Medical Association files another lawsuit over surprise billing ban By Shannon Muchmore * COVID-19 testing startup Curative pivots to health plan offering By Shannon Muchmore -------------------------------------------------------------------------------- * * * * EXPLORE * About * Editorial Team * Contact Us * Newsletter * Article Reprints * Press Releases * What We're Reading REACH OUR AUDIENCE * Advertising * Post a press release * Submit an opinion piece RELATED PUBLICATIONS * BioPharma Dive * MedTech Dive -------------------------------------------------------------------------------- © 2022 Industry Dive. All rights reserved. | View our other publications | Privacy policy | Terms of use | Take down policy. 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