Several physician groups are picking a fight about prior authorizations, something many providers reportedly view as an onerous, time-consuming process that interferes with patient care.
In a policy statement released recently, the AMA, along with dozens of groups including the American Academy of Family Physicians (AAFP) and the Medical Group Management Association (MGMA), laid out a listing of 21 principles that the group contends would improve the operational efficiency and ability to deliver quality care of physician practices around the country.
One of the biggest bones to pick is the administrative-heavy practice of prior authorization.
"Prior authorizations create significant barriers for family physicians to deliver timely and evidenced-based care to patients by delaying the start or continuation of necessary treatment," states AAFP. "The very manual, time-consuming processes used in prior authorization programs burden family physicians, divert valuable resources away from direct patient care and can inadvertently lead to negative patient outcomes."
What would the physician groups like to see? For one, they call for greater flexibility and fluidity among utilization management programs, which should take a patient's specific comorbidities and other health factors into account. Also, they would like to see a revised appeals process, one that allows physicians to have "direct access" to provider in the same specialty to discuss a case.
Another recommendation is to avoid gaps in authorization that may occur when a patient changes insurance and instead let a prior authorization once gained remain "valid for the duration of the prescribed/ordered course of treatment."