As health plans increasingly rely on “prior authorizations” (i.e., PAs) to rein in costs and avoid low-value or overused treatments, medical tensions have intensified in recent years. The problem: patients are forced to wait before getting care, and PAs add another layer of paperwork to an already overburdened administrative process.
In fact, providers indicate that their staff members spend “several days” worth of waiting and an average of 20 hours or more per week obtaining PAs, according to a recent American Medical Association study. In a fully manual process, this typically includes filling out and submitting supporting documents by hand and on paper. Once a PA request is received by a payer, it can take an average of six to seven days to pass through the manual review process. Only then can a provider confidently schedule the procedure.
In a series of provider interviews conducted for us by Leavitt Partners, one of the most consistent frustrations voiced about the payer/provider relationship was the PA process, specifically the administrative burden it places on providers and additional wait times it creates for 90% of patients. Expectedly, this process negatively affects providers’ bottom line.