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  • Writer's pictureMuhammad Sair Khan

Can Prior Authorizations Negatively Impact Care?


If you plan on receiving insurance reimbursement, prior authorization is a necessary step in getting your patients the care they need. According to an American Medical Association survey of 1000 specialists and primary care providers, 91 percent of physicians say that prior authorizations negatively impact treatment and affect patient care in multiple ways.

Delay in Treatment

A third of survey respondents said that prior authorizations often contribute to a delay in care. Even in the most well-run practices, it can be hard to minimize or avoid prior authorization delays altogether.

Most providers, 65 percent, report waiting at least one business day for prior authorizations, while 26 percent wait at least three days. These delays can cause adverse outcomes and even lead patients to abandon treatment. Twenty-eight percent of survey respondents said waiting for prior authorizations led to serious patient outcomes like death, disability, hospitalization, or other life-threatening emergencies.

Reducing Care Time and Overworking Staff

According to the survey, facilities file 31 prior authorizations per physician per week. Filing these prior authorizations takes about 14.9 hours, almost two business days. This administrative time cuts into time that could be spent caring for patients. Furthermore, administrative tasks like this contribute to physician and nurse burnout.

Additional Costs for Facilities and Patients

Around 36 percent of survey respondents said they employ staff specifically for pre-authorizations. Each prior authorization costs around $500 per case and reportedly do little, if anything to improve treatment. These costs cut into the money that physicians and facilities could use reinvest in their patient’s care such as updating their treatment modalities, improving technology, thorough follow up and more.

Less Choice in Treatment

Physicians say that prior authorizations are likely to steer patients toward certain treatments—even if the doctor feels that those treatments might not be optimal for that specific patient. They may affect outcomes data collection, especially if payors are using outdated models to make recommendations and approve treatments.

Tying physicians’ hands in how they treat their patients is another contributor to physician burnout. Many physicians feel that they are at the mercy of the insurance industry and prevented from providing the level of care they think is best. It is also causing providers to discontinue seeing patients with unfavorable insurance policies or only accepting cash payment. This can become a problem down the road, leaving patients with less desirable insurance policies with fewer choices in health care.

Unfortunately, prior authorizations are unlikely to go away any time soon. However, payors are beginning to work with medical associations to find new ways to streamline the process. Digital transactions may lead to faster approvals, while reducing costs.

At Datapro, our experts know how to work with payors and understand what payors are looking for in a prior authorization request. Schedule a complimentary 15-minute consultation with Datapro experts by calling 805-579-3537 or contacting us online.

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