While providers have many legitimate concerns about the PA process, it remains an important tool to help ensure that the care patients obtain is safe, effective, and necessary.
Given the nature of the prior authorizations process, it’s inevitable this practice will lead to some level of provider abrasion; however, the healthcare industry is taking steps to reduce the burden prior authorizations create.
From the provider’s perspective, prior authorization (PA) often represents a series of unnecessary, manual steps that encumber workflows, reduce the ability to focus on the Triple Aim (better care, lower costs and patient satisfaction) and end up sowing distrustful relationships with payers.
A 2019 American Medical Association survey of 1,000 practicing physicians reveals providers’ level of dissatisfaction with PA. In this survey, 91% of physicians reported that the PA process delays necessary care, 64% reported waiting one business day on average for decisions from health plans, and 24% said PA has led to serious adverse events for a patient in their care. Payers also acknowledge that the PA process is far from perfect and does create burdens for providers and their patients.
While providers have many legitimate concerns about the PA process, it remains an important tool to help ensure that the care patients obtain is safe, effective, and necessary. Nonetheless, providers’ PA pain is real, so payers and their IT partners must ensure that the costs of the process are commensurate with their benefits. While it’s unrealistic to expect that provider abrasion resulting from PAs will ever disappear completely, the industry will continue to work to reduce the pain as much as possible.
Melissa Gaffney is the Director, Clinical Solutions and Strategy for Availity, the nation’s largest health information network.