Amid the Texas Medical Association's ongoing advocacy for prior authorization reforms at state and federal levels, yet another survey underscores the patient and financial harms that result from these onerous requirements.
The American Medical Association recently released the survey results, in which 86% of physician respondents reported such requirements led to higher use of health care resources, resulting in waste and driving up costs. Similarly, 89% of respondents said the requirements had a negative impact on patient clinical outcomes.
These findings contradict health plans’ claims that prior authorization is necessary for cost and quality control, says AMA President Jack Resneck Jr., MD.
“Health plans continue to inappropriately impose bureaucratic prior authorization policies that conflict with evidence-based clinical practices, waste vital resources, jeopardize quality care, and harm patients,” he said in a March 13 statement.
The survey also found:
- An overwhelming majority (94%) of physician respondents reported prior authorization requirements delayed necessary care;
- One-third of physicians said such requirements led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death; and
- Only 15% of physicians said prior authorization criteria were often or always evidence-based.
In addition, nearly nine in 10 characterized the burdens associated with prior authorization as high or extremely high. AMA data show medical practices complete a weekly average of 45 prior authorizations per physician, a time-consuming process that sucks up almost two business days from physicians and staff.
TMA, alongside AMA and others in organized medicine, has long sounded the alarm about the consequences of health plans’ prior authorization policies – and fought for change.
At the state level, TMA currently hopes to build on the success of the 2021 “gold card” law, which exempts physicians who earn approvals on at least 90% of prior authorization requests for a given service or medication from onerous preapproval requirements for that service or medication.
TMA spearheaded the law, which appears to be working for many physicians, but there’s still work to be done to ensure health plans are held accountable. TMA Chief Lobbyist Clayton Stewart says the association hopes to revisit the issue this session.
There also are glimmers of hope at the federal level, where the Centers for Medicare & Medicaid Services has proposed a series of changes to prior authorization policies under certain Medicare plans.
Emma Freer
Associate Editor
(512) 370-1383