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    Prior authorization: Caught in an administrative nightmare

    No simple solution to preauthorization process that delays care, burdens clinicians


    Surveys: Prior auth burdensome, costly

    Have you passed along preauthorization costs to patients?Survey after survey points to prior authorization as among the inconveniences and costs to practices that hurt the profession most. In a 2016 AMA survey of 1,000 physicians, including 60% who were specialists, 75% classified prior authorization as a high or extremely high burden. Six percent indicated it was a low or extremely low burden. More than one-fifth of responding physicians said they and their staff spend more than 20 hours a week on prior authorization, and 23% said they complete more than 40 prior authorizations a week. Ninety percent reported delays in care due to the process.

    Also see: AUA pursues revised priorities on Capitol Hill

    Statistics from a study published in 2013 suggest the cost of prior authorization for each full time equivalent physician is from $2,161 to $3,430 a year (J Am Board Fam Med 2013; 26:93-5), and stats from a 2011 study indicate yearly costs of a physician’s interactions with insurers is nearly $83,000 (Health Aff 2011; 30:1443-50).

    Among urologists, prior authorization ranks as their second most pressing concern, according to Urology Times’ 2016 State of the Specialty survey. The same survey showed the problem is getting worse, with 86% of respondents reporting that prior authorization demands are increasing.

    Urologists, in fact, are particularly hard hit. Many of the services urologists provide in the office, from drug therapy to procedures such as urodynamics and cystoscopy, require prior authorization, according to Dr. Ferragamo.

    “More personnel is needed in the office just to do these authorizations. In our office, with five urologists, we have two secretaries that all they do, day in and day out, is get authorizations,” Dr. Ferragamo said.

    Making matters potentially worse, a white paper by the Physicians Cardiovascular Disease Working Group published in late 2016 pointed to a North Carolina health insurance plan that requires physicians to pay $250 to file a second appeal.

    According to statistics cited by the AMA, prior authorization requirements are growing. In the 2015 AMA presentation, “Break Through the Prior Authorization Roadblock,” presenters indicated there has been a 20% increase per year in drug prior authorizations.

    Read: MedPAC proposals seek to mitigate Part B spending

    All this, and prior authorization is not a guarantee of payment, even when a service or prescription is authorized.

    Next: “You always feel like you’re being second-guessed."

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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