Physicians fed up with prior authorization

MSSC physicians say prior-authorization require­ments delay access to necessary care and negatively impact clinical outcomes. What’s more, the problem is getting worse.

Last month, MSSC surveyed 812 of its members who regularly deal with prior authorization. For comparison purposes, it asked some of the same questions as a 2024 national survey by the American Medical Association. Of the 116 MSSC members who responded (14.3%):

• 43% said the prior-authorization process always delays access to necessary care (15% in AMA survey), and another 50% said it often delayed necessary care (42% AMA).
• 98% said the delays had a significant or somewhat negative impact on clinical outcomes (94% AMA).
• 90% said the number of PA denials increased significantly or somewhat over the past five years (75% AMA).
• MSSC physicians and their staff spend an aver­age of 13.7 hours per week completing PAs (13 hours AMA).
• 93% said they were concerned that health plans’ use of artificial intelligence will increase PA denial rates (61% AMA).

MSSC will use the results of the survey as it advo­cates for prior-authorization reform in Congress and the Kansas Legislature.

At the federal level, MSSC is a signed endorser of the Improving Seniors’ Timely Access to Care Act (H.R. 3514 and S. 1816). The bill, which is being championed by Kansas Sen. Roger Marshall and has bipartisan support, seeks to curb the overuse and abuse of prior authorization by Medicare Advantage plans.

MSSC also supports PA reform at the state level for private insurance plans, such as a “Gold Card” pro­gram in which physicians qualify for a preauthorization exemption for certain healthcare services.

MSSC members are fed up with the delays and roadblocks. As one physician said, prior authorization “causes massive headaches for doctors who need to be using our time and energy caring for patients.” Or as another succinctly said: “It is time-consuming, mind-numbing and frustrating as hell.”

Docs sound off on PA

MSSC asked physicians to share their thoughts on prior authorization. Responses included:

“Prior authorizations are so incredibly burdensome, contributing to delayed care, worse outcomes, staff frustrations and burnout.”

“The PA process not only negatively impacts patient care but increases costs to our medical practice and is a factor in serious economic difficulties facing medical practice in general.”

“The rules used by insurance for approval are not based on evidence-based medicine, literature or guidelines.”

“I’m trying to care for my patients in the most appropriate manner based on evi­dence, and some computer algorithm or uneducated reviewer trumps my medi­cal judgment. This delays treatments and makes patients angry. They blame me even though it is outside my control.”