The AMA conducted a web-based survey of physicians to ascertain the impact prior authorization (PA) is having on their ability to help their patients. PA is a health plan cost-control process that restricts access to treatments, drugs and services. This process requires physicians to obtain approval prior to the delivery of the prescribed treatment, test or medical service, in order to qualify for payment.
Originally, PA was designed for newer medications or procedures that were more expensive than the traditional methods. Now the practice has spread to routine items that are neither costly nor new.
Over 90% of the respondents indicated that PA had a significant or somewhat negative clinical impact. Nearly three in ten reported that PA led to a serious adverse event for a patient in their care such as a death, hospitalization, disability, permanent bodily damage, or other life-threatening event . The administrative burden of PA has become high or even extremely high. Also frustrating is that PA is regulated by state law in many states, while other states do not have a specific law.
The time frame for the reviewer to respond to urgent matters ranges from 24 to 72 hours to a “reasonable” period of time. In clinical reality, timely access to care can be a life or death matter.
1 in 4 doctors say prior authorization has led to a serious adverse event
Streamlining the Insurance Prior Authorization Debacle
Transforming Prior Authorization to Decision Support
Take a post-test and get CME credits
TAKE THE POST TEST
Please log in to ObGFirst to access the 2T US Atlas
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
