Prior Authorization
Prior authorization (PA) is a process that markedly increases administrative demands on physicians in clinical practice and compromises patient care. In 2023, AMA research demonstrated that:
“The PA process continues to have a devastating effect on patient outcomes, physician burnout and employee productivity. In addition to negatively impacting care delivery and frustrating physicians, PA is also leading to unnecessary spending (e.g., additional office visits, unanticipated hospital stays and patients regularly paying out-of-pocket forcare).”
Since 2018, our Physician Well Being Action Collaborative has focused on prior authorization reform. Specifically, we have been working with insurance company executives, physicians, hospital administrators, local medical societies and others to bring prior authorization capabilities and medication costs and alternatives to physicians at time of service via the electronic health record.
We have made significant progress. We have reduced prior authorizations by over 50% in some instances, coordinated prior authorization grids and started to build the infrastructure needed to accomplish our goals. Most importantly, we have cultivated a strong network of diverse individuals who openly and respectfully share ideas, insights and experiences with each other, and are committed to doing this work together.
If you would like to learn more, please connect with us!
Resources
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Prior authorization is a cost-control process requiring health care providers to qualify for payment by obtaining approval from health insurers before performing a service.
The AMA believes that prior authorization is overused and existing processes present significant administrative and clinical concerns.
The AMA’s multifaceted approach to the prior authorization challenge includes research, practice resources and reform resources.
Visit AMA’s Prior Authorization Initiative Reform for a comprehensive list of resources.