AMA meeting: AMA urges Web system for prior authorizations

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Chicago -- The use of Web-based prior authorization services could help physicians reduce the amount of time and money spent on dealing with insurance companies, according to policy adopted by the AMA House of Delegates.

The policy calls for the Association to support federal legislation requiring all health insurers to include Web-based services among options for granting prior authorization.

"I've known for a long time it was costing me a lot of money to deal with insurance companies and I realize you all know that, too," said Charles Hoffman, MD, an internist and delegate from the Oregon Medical Assn., which introduced the resolution.

Dr. Hoffman said a recent Health Affairs article put the problem into perspective with a report that each U.S. physician spends, on average, $70,000 each year resolving insurance-related issues.

Dr. Hoffman said the idea for the resolution came from his nurse-managers, who told him several insurers offer Web-based services, which are quicker and more efficient than spending several hours on the phone, the way disputes have traditionally been resolved.

The Health Affairs study, published online May 14, found that practices' interactions with insurers cost $23.2 billion to $31 billion a year. Primary care physicians were found to spend the most time -- estimated at more than four hours per week -- dealing with insurance issues, compared with other specialists.

Last year the AMA launched its "Heal the Claims Process" campaign to address the obstacles physicians face in getting paid for care. The AMA found physicians spend as much as 14% of their revenue on efforts to get paid promptly and for the contracted amount.

The Health Affairs report called for health plans to invest in making claims payments faster and more accurate, but didn't specify a need for Web-based systems for prior authorization.

There was some discussion at the House of Delegates' June Annual Meeting as to whether the issue should be addressed at the state or federal level, as insurers sometimes have different plans in each state they serve.

Lynn Parry, MD -- a neurologist who is an alternate delegate for the Colorado Medical Society but spoke for herself on the house floor -- said making it a state-by-state issue would only give the insurers an excuse not to implement the systems in states without laws.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said the group is in favor of any health information technology that helps streamline the administrative process.

The group joined the AMA and other national health care groups in signing a letter to President Barack Obama that detailed ways the health care system could reduce its spending by at least $1 trillion.

AHIP supported a mandate on the use of technology to streamline five key administrative functions: claims submissions, eligibility, claims status, payment and remittance.

Zirkelbach said within the next month AHIP will pilot a Web portal in two states to allow physician practices to interact with all contracted insurers through one site.