As many as nine out of 10 physicians say that prior authorization has a negative effect on patient outcomes, according to AMA’s survey of about 1,000 physicians nationwide. This can lead to negative patient outcomes, including avoidable hospitalizations and delayed treatment.
Now, physicians are employing AI as a means of pushing back against insurers' use of prior authorization, according to a July 29 article in Computerworld.
According to the report, AI is used to generate "batch denials" of coverage requests by physicians. Physicians must then appeal denials in an attempt to get procedures authorized for their patients.
While payers are utilizing AI to streamline their end of the prior authorization process, some physicians see AI as a powerful tool to combat their administrative burden, too.
Epic Systems, one of the largest EHR companies in the U.S, has rolled out AI tools designed for handling prior authorization quests to a small pilot group of physicians. Other health systems are already using an AI tool called Doximity GPT, a HIPAA-compliant version of ChatGPT.
Doximity claims that out of their 2 million users, 80% are physicians. Last year, a company survey found that out of about 500 physicians who were piloting the platform, Doximity could save them about 12 to 13 hours a week in administrative work.
While physicians' questions and concerns about the privacy and safety of AI remain, some who do utilize it are vocal about the potential benefits.
"I’d say it's got to be less than 1% of physicians," Ashish Kumar Kha, MD, and dean of the School of Public Health at Brown University, said."It's just that if there are a million doctors out there and it's 1% of them, then that's 10,000 doctors using AI. And they're out there publicly talking about how awesome it is. It feels like all the doctors are using AI, and they’re really not."