Cost and Time Burdens of Prior-Authorization Increase

Earlier this month, the Council for Affordable Quality Healthcare (CAQH) released a report that uncovered the burden of prior authorization increased in 2019. That means that physicians are spending more time on administrative paperwork, phone tag and repetitive conversations with layers of middlemen instead of in exam rooms treating patients. This delays care and obstructs thoughtfully crafted treatment plans

The CAQH report found that the volume of prior authorization increased in 2019 and in that year the cost to process prior authorization requirements was $528 million. The heaviest burden is “manual” prior authorization which requires use of paper forms that are faxed from a physician office to a health plan. Fax machines are a 35+ year old office technology that has been almost wholly replaced in many industries by more efficient forms of near-instant electronic communication; there’s a lot of room here to modernize the process. Each manual prior authorization transaction takes a physician (or nurse, or practice manager or billing specialist) 21 minutes while fully electronic prior authorization transactions take only 6 minutes. According to CAQH, there were 27 million manual prior authorizations in 2019. Those 21 minutes could result in a patient waiting in a treatment room wondering when the doctor is going to see them or a concerned caregiver not being able to reach a nurse when she calls about a loved one’s symptoms, or a particularly long hold time when calling to schedule an appointment.

When pre-authorization processes are deliberately difficult and driven by cost containment goals rather than concern for patients, priorities are dangerously off-track. Legislation has been introduced that would streamline prior authorization so doctors can do what they have been trained to do, care for patients. The Improving Seniors’ Access to Timely Care Act, H.R. 3107, has been endorsed by over 370 patient and medical provider organizations. Patients and Providers United amplifies the voices that seek to keep patients and providers at the center of medical decision making. Putting a middleman, with inadequate clinical experience in the medical decision making chain undoubtedly disrupts the personalized treatment plans that physicians carefully develop for each patient and restricts real-time decision making by doctors.