Credit: Asier/Adobe Stock
Most U.S. physicians who need to check with health insurers before providing care think that prior authorization reviews hurt the patients, according to the American Medical Association.
About 92% of the physicians who participated in a recent AMA survey said the prior authorization review process has a somewhat or significantly negative impact on care, and only 2% said they thought the process has a somewhat or significantly positive impact, the AMA said.
The Centers for Medicare & Medicaid Services has started a voluntary effort to bring health insurers, technology services companies and large health care systems together to establish electronic prior authorization communications standards and streamline the review process.
Only 33% of the AMA survey participants agreed with a statement that the CMS effort would make a meaningful difference for physicians, according to the AMA.
The sample included 1,000 practicing physicians, including 400 primary care physicians and 600 specialists.
What it means: Many of the physicians who are treating the participants in employers' health plans are still unhappy with health plans and health insurers.
The backdrop: Dr. Mehmet Oz, the CMS administrator, is a cardiothoracic surgeon, and he has pledged to try to reduce the number of procedures subject to prior authorization reviews and make health care system players adopt the technology standards needed to move more reviews through standard electronic systems.
Most big payers are participating and saying they will make big improvements by Jan. 1, 2027.
CMS announced an initiative Wednesday to accelerate development of technology standards and get standards in place before 2027.
Twenty-nine organizations, including Aetna, Cigna, Elevance and UnitedHealthcare, have joined the standards acceleration initiative.
AMA survey details: The participants in the AMA survey who go through prior authorization reviews estimated that their practices complete an average of about 40 prior authorization reviews per physician per week.
About 94% said of those participants said the review process somewhat or significantly increases physician burnout.
Only 16% of the doctors who go through "peer reviews" said they thought the "peers" conducting the reviews often or always had the right qualifications to serve as peer reviewers.
About 23% of the physicians said the burden of prior authorization reviews was extremely high for Medicaid and Medicare Advantage plan patients, and 11% said the burden was extremely high for patients with traditional Medicare coverage.
For patients with commercial coverage, the percentage who rated the review burden as extremely high was 16%.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.