Physicians and their staff feel increasingly burdened by prior authorization requirements, according to Medscape's "'They're Awful and Impede Patient Care': Medscape Physicians and Prior Authorizations Report 2024."
Approximately 39% of physicians reported spending slightly more time on prior authorizations than they did three years ago, while 27% said they spend much more time. About 80% of surveyed physicians also said that medical staff spend more or much more time on prior authorizations when compared to three years ago.
This trend has led to frustration among physicians, especially those in independent practice, who view the process as a drain on time and resources that can harm patient care. "Prior authorization does absolutely nothing except try to save insurance companies money once we finally give up. It does nothing for the patient or the doctor. It costs physicians time and money and only delays appropriate treatment," Klaud Miller, MD, an orthopedic surgeon and medical director of Windy City Orthopedics and Sports Medicine in Chicago, told Becker's.
According to the Medscape survey, 86% of physicians said the time spent processing prior authorization requests or appealing denials often delayed patient care. Additionally, 61% said that patients frequently abandoned recommended treatments due to prior authorization delays.
"It's meant to be a financial tool to help offset costs of care for a person, but it's not," Rory Murphy, MD, a neurosurgeon with Barrow Brain and Spine group in Phoenix, told Becker's. "It seems to have swung the other way, essentially, [and is] now a system to ration care. They're actively trying to avoid paying."
When asked about potential reforms, 51% of physicians in the Medscape survey said they supported uniformity among payers.
Ashutosh Kacker, MD, an otolaryngologist with Weill Cornell Medicine in New York City, noted that a national standard for public and private payers could relieve the often opaque and confusing processes set by health plans.
"The problem is Medicare per se may have one criterion, Medicare Advantage or Oxford or Cigna may have totally different criteria for the same problem…which doesn't make sense," Dr. Kacker told Becker's. "If you have a national standard, in which we know these are the standards to meet before we pre-authorize anything, it would make life so much easier."
Dr. Kacker also emphasized that while prior authorization can burden physicians and their practices, patients ultimately suffer the most.
"There's no one else except the patient who gets hurt," he said. "For me, if somebody's in line to get pre-certified, and I can't get peer-to-peer or approval without a three-month appeal process, we'll always have somebody else to fill that spot. So it's not that my time goes un-utilized. It's the poor patient who then gets stuck between the insurance company and the pre-authorization approval and the care they need."